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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> /111^/S ---A <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov www. NAC <br /> 1 t PROJECT SI`,TE IN_FORMATI N . 'fir s <br /> PROJECT SITE ADDRESS: 01\ ; nw PROPERTY TAX#: /jam435=fl 00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (,(,• (attach copy of long legal description) <br /> 1;, <br /> OWNER NAME: A 11004th L0411 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET S(Y) i l/v,cI a r <br /> CIN Eve✓;�-- f STATE 1//4 ZIP elmT. <br /> OWNER PHONE:�(�f/—i 71 – V�- JJJ OWNER EMAIL: �__lll <br /> CONTRACTOR NAME:'1 tit rli2ine <br /> CONTRACTOR ADDRESS: STREET/`I�'C Z� f 3+ (3(1 J 4*i / ��J/�% <br /> CITY Hi I STATE t / /2F ZIP I4 "a <br /> CONTRACTOR PHONE: `I25`7-11- 131 CONTRACTOR EMAIL: -- <br /> CONTRACTOR <br /> �'V��'111 <br /> CONTRACTOR LICENSE#(REQUIRED) LUEF f j S3 (. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):0SZ1Q® <br /> PRIMARY CONTACT: 0 OWNER „CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACTAME: �; baryoh <br /> � CONTACT PHONE: 1i�J(Z1 q_"711 --if 31 <br /> 'lLi° F'f, - • ACT EMAIL: ) 1.2/t/p7 l <br /> APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ ‘061)D.I/ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: 03BFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-it of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew .'Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> irS6\ <br /> ASSOCIATED BUILDING PERMIT it(if applicable): <br /> MECHAN CA P R KNIT PPLIC TION ,,,'' A "'' ''ii LUM I G P I "APPLICATION ' , ;,'', <br /> Type of Project: _New Addn Alteration _Repair Type of Project: _New Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> I A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water 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 /> SPRINKLER SUPPRESSION"SYSTEM' <br /> I 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 with <br /> current federal,state,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.1 am the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> /ggg _ NINIA <br /> PERM \.9)00?„, <br /> 0, er/ArDateO� l <br /> (Revised 10/12/2015) <br />