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IIPERMIT APPLICATIOI),.�I <br /> "1111107-/ --4 <br /> BUILDIN''II�� MECHANICAL/PLUMBING I <br /> SIGN SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ' S' 5F j.oev 4 iAAtt Lag y ` I®#PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision / Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION' <br /> OWNER NAME: TENANT NAME(If Commercial): --pckeN /lt,tss� ca <br /> OWNER MAILING ADDRESS: STREET t <br /> CITY STATE ZIP <br /> OWNER PHONE: ) OWNER EMAIL: <br /> CONTRACTOR NAME: r//e i ,, <br /> fig)/n <br /> /ad -t i LAA <br /> CONTRACTOR ADDRESS: STREET 165'24 s r . 1(4'' J'ii-. <br /> CITY Zp,A10 el STATEAZIP l 80 <br /> CONTRACTOR PHONE: L}s- _co 2-2.-?33 CONTRACTOR EMAIL: /'W#141444 4 e yc�oe,C- <br /> CONTRACTOR LICENSE#(REQUIRED): 4. [-L a AA A/4-4-',.'Zc.p CITY OF EVE IRETT BUSINESS LICENSE#(REQUI'. D): 9 l 1 <br /> PRIMARY CONTACT: ❑OWNER ISLCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:J ( <br /> eF , 0 /j 5 j CONTACT PHONE: Li�3- - 5yy"), - X73 3 <br /> CONTACT EMAIL: i I1 y14,3 oa 6 Ce)plot <br /> BUILDING PERMIT APPLICATION 61060-- <br /> Existing Use of Building: v�.vt.1e R 424aContract Price of Work: <br /> Proposed Use of Building: /t4 u S 4-1 I, Heat Source: ❑Gas gElectric IIP• her <br /> Building Type: OSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ' ommercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.1. 16ign OSprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: z-1,,,344 l) p vic $ei. L E° i t 1,..wi i'.vto.}ed ciicvt,,,,d.P /e.#to"Qc ( <br /> [may 57�1�'f� , S f'1 to <br /> T_ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project _New _ Addn _Alteration _Repair Type of Project: _New Addn _Alteration Re . <br /> #of List of Fixtures #of List of F- res #of List of Fixtures #of L of Fixtures <br /> Fixtures Fixtures Figures Fixtures <br /> A/C—Air Handling Units He--'ump Toilet ,Ba w Preventer(Inside Bldg) <br /> Forced Air Systems ,'it Heater Bathtub rinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower " Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Dispos. Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hook Other: Clothes Wash- Medical Gas <br /> Range Hood Water Heat Other: <br /> Exhaust Fan Sink(S., ice/Bar/Mop/etc.) Other: <br /> SPRI ER/SUPPRESSION SYSTEM <br /> Iemical or Water I INo.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.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 71R09 <br /> caner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> 0 <br />