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0477. PERMIT APPLICATION <br /> BUILDING/MECHANICAL I PLUMBING I SIGN 1 SPRINKLER/DEMOLiTION • <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetfeps@evereifwa.gov j www.everettwa.gov/permits J <br /> (Blue•®rblackc Ink®.n(361le se) • • .przipzgy'tn INF®AM ICAC •• • • • <br /> PROJECT SITE ADDRESS: CM — Lid t4 t so !PROPERTY TAX#l:: ' <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> - /' .Coad t A1er 1 ® ` ioN . . . ' • • • • ' .• <br /> OWNER NAME: 8(,/,�LvJV (� b lj ) lTENANTNAME(If Commercial): <br /> OWNER MAILING ADDRESS: srs>Er `2G4 - `766 sw) /J • <br /> CITY 0"�e "--J STATE , ZIP "�t <br /> OWNER PHONE:(°ZZs) go I I 1:2-1 .... . )OWNER EMAIL:...., .... h (. ,_ o....,.,•HM m� «.. .. <br /> CONTRACTOR NAME: E. t.)OR a AJ 6TWIT: f-fc"6-7-po A-c. <br /> CONTRACTOR ADDRESS: smear 94'2--o ( l c Act)e <br /> 8FITY EUM STATE (Ai k- 21p V Sgai <br /> CONTRACTOR PHONE: 4'15,2.c 2./Jf•J1-1 • !CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE~#(REQUIRED): Evtkl'd: SS c.2.s0„i" 'CITY or EVE,RETT BUSINESS LICENSE#(REQUIRED): C9 6'7 y <br /> PRIMARY CONTACT: ElOWNER `I .CONTRACTOR pOTHER(Please Specify) y. �..._.� <br /> CONTACT NAME: CONTACT PHONE: °.L 7 5-_j -WO <br /> 12.L-1.....1 CONTACT EMAIL: kL•,4) y?Ge-f:t, C(Sl�t <br /> , - , . .. BurLeiNG.IP'r' mir APP,Lr'dan1014. • • . - •• • ••. • ; •, • <br /> Existing Use of Building: / Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: EGas DElecfrric ❑Other <br /> Building Type: CiSFR-Detached CISFR-Attached DDuplex EDMulti-Family-#of Units: DCommerclal EIlndustrial <br /> Type of Project: ElNew DAdditlon EiRemodel ❑Repair 41A.I. EISign OSprinkter EiDemolition ElChange of Use <br /> DESCRIPTION OF WORK: UMcC.rt-(2) 2.ai--1 I %..M 5 H .-c gt/4 rze-,—. ' <br /> ASSOCIATED BUILDING PERMIT#(if a.•Ilcable): <br /> . : :M.ECI1J%` ICAlb IPi RNiIT APPLIC;A a I®Ih9 • , IPLUIVIiift{®10211iVil`t>�Al P>t.iCATil0 ii : • ' <br /> Type of Project: New Addn Alteration__Repair j 1 Type of Project:_New Addn •_Alteration _Repair <br /> #of List of Fixtures "of List of Fixtures `#of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NG-Air Handling Units ' j 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 FireplaceWood Stove Kitchen Sink&Dls.osal 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/Mopieto.)—Other: ' <br /> 1 11111111111111.11111111 .111111111111111111111111.111.1111 <br /> : :.SP[RlNKLER I SUPR SSl®N SYS'Tf ivi ' '_ I' 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 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 circa!stance.i am the owner,orl am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contracto s Law 18 'CW and 2•,.200A WAC, <br /> City ofEverett Official Use Only <br /> PERMIT <br /> _ "4,4 / ,- .7 d \ O (o <br /> ° <br /> )wner/Authbrtzed Age Signature Date (Revised 0/2096) , <br />