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PERMIT APPLICATION <br /> /�1►�� BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blrlle cc-Stack 1n.: OO <br /> PROJECT SITE ADDRESS: (OOH ICH PI SE. PROPERTY TAX#:(Ja'(DOOCC 1000 , <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> t Dtr TACT INFORMATION <br /> OWNER NAME: ! t � TENANT NAME(If <br /> t�Qc� � ���td ��,�.r�-e-cwi Commercial): <br /> OWNER MAILING ADDRESS: STREET i�i u� `^ P! 5` <br /> CITY 4 ,V4STATE WK ZIP 9$r <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: K 1 VlA-5 <br /> CONTRACTOR ADDRESS: STREET Li Cti al i MSW , u i k G <br /> CnY L-" 6AJ)C C I- STATEGit7it ZIP 9 Q U S�.1! <br /> CONTRACTOR PHONE:( gW,S 2, CONTRACTOR EMAIL: 1 p,f,� ,CY <br /> CONTRACTOR LICENSE#(REQUIRED):'�(�7N 6141. 0 A CITY OF EVERETT BUSINESS LICENSE#(I UIRED):( ® <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: --CONTACT PHONE: (i c) 614 cio <br /> � CONTACT EMAIL: -PIT irt"i.�- vG I d la (-(cyr\ <br /> .w. . , I3 f 01# O P0II ' "A#:PLrCkTiO* :' <br /> Existing Use of Building: Contract Price of Work:$ 1'54'6 <br /> Proposed Use of Building: Heat Source: Nes 0 Electric ❑Other <br /> Building Type: ❑SFR-Detached ASFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> NOARA 1( CMC )t <br /> ASSOCIATED BU IN'PERMIT#(if applicable): <br /> MECHANICAL;PERMIT'APPLICATION PLUMBING'PERMIT APRLICATION'' = <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: _New _Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> 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 /> !Chemical or Water ! INo.of Heads <br /> ACKNOWLEDGEMENT.I .ve 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,a•:b al law. 'e granting of a•=rmit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official befo be g aut • ed -•-r any ci%mstance.I am t•-owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> a •I...in. with t -St.to Co. -cto18.27 W a •296. �s' AC. <br /> 0City of Everett Official Use Only <br /> PERMIT# 801-- <br /> 0 urr/A r orizeT A•'S f`, ature Date (Revised 9/23%2016) <br />