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PERMIT APPLICATION <br /> "IIIIIIIP---- BUILDING I MECHANICAL I PLUMBING I SIGN I SPRINKLER 1 DEMOLITION • <br /> .0 ' _ CItY OF EVERETT PERMIT SERVICES <br /> T 3200 CEDAR STREET,EVERETT,WA 98201 <br /> • (P)425-257-8810 J FAX 425-257-8857 I(E)eyerefteps@everettwa.gov I www.evereftwa.gov/permits . <br /> (fitae®r'aIaCk IA Orgy.l tealse) • PROMO'S Ti h DalF0IIiMA'rtOIkT • • • •• . <br /> PROJECT SITE ADDRESS: I52•G •- Li _ f _- V` (L, PROPERTY TAX#: , <br /> LEGAL for new construction: Short Piat/subdivision Lot No. (attach copy of long legal description) <br /> • • . • . . ..coNtAdg iiviv®tiMTiom •. • . <br /> OWNER NAME: t,.y1-4e &�., TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET i,625- El. b-m f12(LE U I .,,..)bp__ <br /> CIT( - 0 w STATE ZIP ; <br /> OWNER PHONE: ( J 2S! _ /7 L•(^7 OWNER EMAIL: • <br /> CONTRACTOR NAME: E U zL i..) 6` tiro (46�Z'-Wr.�-c- <br /> CONTRACTOR ADDRESS: STREET 2-f �l�CdU, <br /> . • <br /> CITY .UK'i STATE (Al/A- ZIP Ci S20/ <br /> CONTRACTOR PHONE: 4'2.5,2.52..-311 ci • CONTRACTOR EMAIL: f�8.s'1 Q.X.S'S/1-j tiic,ed« <br /> CONTRACTOR LICENSE#(REQUIRED): EUtS12.65S®zzo-" ICrrY o f EVERETT BUSINESS LICENSE#(REQUIRED): El tri x45'5' <br /> PRIMARY CONTACT: }E OWNER MaCONTRACTOR Q OTHER(Please Specify) 1M ............ M -~'~"~ • <br /> CONTACT NAME: 7 CONTACT PHONE: t4 .. 5'2„-,//9 <br /> CONTACT EMAIL: <br /> •':. -- " BUILDING f? E in,APPLiCATIOtd • • • •• - • .• • , • <br /> Existing Use of Building: i Contract Price of Work:$ )t fid <br /> Proposed Use of Building: Heat Source: QGas llecfrlc [Other <br /> Building Type: [SFR-Detached QSFR Attached QDupiex ❑Multi Family#of Units: 1 Commerclal [industrial <br /> Type of Project: QNew [Addition QRemodei [Repair I. [Sign CJSprinkier [Demolition [Change of Use <br /> DESCRIPTION OF WORK: ckijI ext._ (J(.(.L-F S f►tit 5.L/5't22 6=C)tz_ 63- ' <br /> COul-Dopi2_ Li fsj tT i S ae,04145 (ti.4CY..4./T7z9 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): _ <br /> .Nf ct ANi1CAL PB IYIITi APPLICATION I . PLUIVIAING PEI�IVIITi APPLICATIORI •--_ <br /> Type of Project: _•New Addn _Alteration Repair Type of Project: New _•Adds Alteration Repair 1 <br /> #of List of Fixtures #of 1-1st of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures fixtures Fixtures <br /> I NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater <br /> Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Wafer Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc,) Other: <br /> :'SPRi SWLER/SUPPP. SSION SYSTEiVI I ' <br /> (Number of Heads ! <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the Information contained herein is true and correct.Work done pursuant to this permit must comply Ivith <br /> current federal,slate,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized In writing from the <br /> Building Official before being authorized under any circumstance.i am the owner,ori am authorized by the owner of this property to perform the work forwhfch application Is made, <br /> and/comply with the State Contractors Law 18.27 RCW and 296.200,4 WAC. <br /> City of Everett Official Use Only <br /> 4.1._____ PERI i ' 6/3 <br /> Owner/Authorized Agent Signature Date (Revise 5/20/2098) • <br />