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1 <br /> 04. PERIIIII T APPLICATION <br /> BUILDING I I ECHANIC.AL.I PLUMBING I'SIGN(SPRINKLER!DEIIIOLITI•Iii <br /> CITY OF EVERETT PERMIT SERVICES3200 CEDARSTREET,EVERETT,WA-98201(P)425-257-8810 f FAX 425-257-8857 1(E)everetteps@everettwa.gov I ivww.everettwa.gav/permits <br /> (Blue 611,SIack Ink Only Please) PRQdl CT S T INFORMATION <br /> PROJECT SITE ADDRESS: k t!! ,f4974iIL4 5 _e / ✓.lit °ROPERTYTAX fk <br /> LEGAL for new construction:Short Piat/subdivision Lot Jo. (attach copy of long legal description). <br /> CONTACT.INFOR4Vi1A 'ON . <br /> OWNER NAME: Z-'" ,-"Cve t r i 6 0NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET l(( 0 (.-""Vdr <br /> C17Y ti..- t t STATE Cx.,K z ZIP 7" i 17 <br /> OWNER PHONE it,; i - OWNER EMAIL: <br /> CONTRACTOR NAME: G Ud;6 AJ 3`T'Kk" L i tl1 , <br /> CONTRACTOR ADDRESS: smear '2-1'2,0 Cwt Pct. AU it • <br /> GTt e Li <br /> CR- <br /> STATE CA.,.01,- ZIP Ci ta24/ <br /> CONTRACTOR PHONE: 4-2-5.2c 2-"3t tq . CONTRACTOR EMAIL: Q A...4e j S7r.'ite24..ee)t 1 <br /> CONT€2ACTOR LICENSE#(RI QUIRED) rG(3GY i a ayi-to !Fir{OF EVERETT BUSINESS LICENSE t(REQUiRED) �)6/1.>a- <br /> PRIMARY CONTACT: 0 OWNER aCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: • CONTACT PHONE: 4 7 se-2.51-,.//9 <br /> K.L., 1,3 ' (_o CONTACT EMAIL; 14.4`, e6,5 Llllt l <br /> • • Buil 1iNG P'R MMJT APPLiCATtON • - •. • . <br /> Existing Use of Building: i <br /> Contract Price of Work:$______I__•__AZir <br /> Proposed Use of Building: Heat Source: ' asgc lectric CIOther <br /> Building Type: OSFR:-Detached OSFR-Attached ElDuplex OMuitl-Family#of Units: I ommercial Dindustria! <br /> Type of Project: ONew OAddition ClRemodel 0Repair CiT.I. ['Sign ['Sprinkler ['Demolition OChange of Use <br /> DESCRIPTION OF WORK:64.0,4„.1 a„, ('Z- ` t , t 4..i~::hf"„ p,(„46 „Kirk ak77 ; <br /> T I3 LIvIT`.S At f tace,vt) 144e4€1-47:59 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> M.BOHJ1NIOAL,PERMIT A PPLIcATIOI ; PLW IWING PERN'iT APPU CATION <br /> Type of Project: New Addn Alteration_•_,Repair Type of Project:-_^New Addn Alteration Repair t <br /> #of #of �#of #of <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NM.NC-Air Handling Units 'L, Heat Pump Toilet Backflow Prevenfer(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 Drier Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> -SPRINKLER f SUPiP RBS [ON SYSTE1'JI <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 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 /> But/dfngOfficial before being authorized under any circumstance.I am the owner,ori em authorized by the owner of this property to perform theuork for which application is made, <br /> and l comply with the State ContractorsLaw 18.27RCW and 296 200A WAC. <br /> City ofEverett Official Use Only <br /> PER <br /> I ill 064c5b- 4:q I <br /> Owner/Authorized Agent Signature Date (Revised 512012018): _ <br />