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PE62M{T APPLICATION� <br /> -' � � ` BUtLD1NG ECH/�NICAL/ PLUMBING/ SIGN / RtNKLER/ DEMOLITION <br /> C{TY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 9820-I <br /> (P}425-257-88t0 � FAX 425-257-8857 �{E)everetteps@everettwa.gov� www.everettwa.govlpermits <br /> (Btue or Blacic!nk Onty Please) PROJECT SI�'E INFaRM/�!'('IVP! <br /> PROJEC7'SITE ADDRESS: �j aQ t���L S i• � I�� PROPERTY TAX#: $Q�y'I'�pp�0o�,�Op <br /> LEGAL for new wnstruction: Short PlaUsubdivision Lot No. {attach Copy of long legal description) <br /> C�N'�'AC'� II�FORMATION <br /> OWNER NAME: LAGt� �� (�L�}i A V)�..LH L,�.•�. TENANT NAME(If Commercial): �C�a�L. �iOi�lE <br /> OWNER MAILING ADDRESS: srneEr ��o't(a ��. cZ`y�-�t. 52�1'fE c2(3 <br /> Cmr E�IEIIC�FZ �fJLA1�1I� STATE �P9- ZIP 7�O I� <br /> OWNER PHONE: �a,b., yy� � �� OWNER EMAIL: �(J�(� �ATiNARFAI.�S'r/1TL.�OM <br /> CONTRACTOR NAME: r.('tl;�0�? �� _�L.� �'� � <br /> CONTRACTORADDRESS: sr�Er ''/r,.�.L(� SL �"�� <br /> CITY ��`GI"��� S STATE ��lS�1 ZIP � � ! <br /> CONTRACTOR PHONE: �� �2�j(A !-.� CONTRACTOR EMA1L: �* 7.- 1,�,��'�'��, � ,LpalVl <br /> .--,�•� .. '���� `I <br /> CONTRACTOR LICENSE#{REQUIREDj: �. � - �E (L � CITY OF EVERETT BUSINESS LICENSE#(REQUIRED} ' � '� <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Piease Specify) <br /> CONTACT NAME: CONTACTi PHONE: � <br /> C�1�� � �U���r,� ��,� _ .� c: _ ��;/ (�, <br /> � ` "'� �"� CONTACT EMAIL: .���' '� {��c= cl• � �PII <br /> � BUi1.DING PERMIB'APPLICA't'IOEti <br /> Existing Use of Buitding_ Contract Price of Work:5 � <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑O[her <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial Dlndustriai <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkier ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK_ <br /> ���\�ik4-1 1'J�y � �1'O�PL�l �r.�l,T ��s �e lJ� t'�l��U��rC�� <br /> �-I o tM,� � ���lS���t� �'�i v''�-�r�� , <br /> ASSOCIATED BUILDIMG PERMIT#(if applicable}: <br /> MECHIiNICAL PERMIT APPLICi�TiON PI.UMBiPlG PEiiMIT AP�'L.IGA'SiOP! <br /> Type of Project: _P7ew _ Addn _Alteretion _Repair Type of Projeci: New ,_Addn _Alteration Repair <br /> #of — — <br /> Fixtures List of Fixtures #�f List of Fixtures #°f List of Fixtures #of <br /> Fi�tttrres Fixtures Fixtures List ofFixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 8athtub urinai <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 <br /> Other: <br /> Exhaust Fan Sink(ServicelBarlMop/etc.) Other. <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Neads <br /> aC►cnrowcEo�en,rEnrr-�nave reviewed this application and con�rm the information contained herein is true and correct.Work done pursuant to this permif musf comply with <br /> CU7ent fedel8f,St8t6,elld IOCef 18W.ThE gfeDting Of a permit only authorizes approved work and no deviations therefiom.Deviations must irst be authorized in wrifing fram the <br /> 8uiltling Oflicial before being authonzed under any circumstance_I am the ov ner.or 1 am authorized by the owne�of this property to pe`fomi[he work for whiCh applicatiOn i5 made, <br /> and/COmply with the State Contractors Law 18.27 RCW and 296.200A WAC_ <br /> .,,-�� <br /> �� /'� � City of Evereft O�cial Use Onfy <br /> PERMIT# � <br /> - `�" S- -��' -��7 '���l � ' '� <br /> lAuthorized Agent 5ignatur Date (Revised 5/20/2016) � <br /> �� <br /> 2— <br />