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4rE77. PERMIT APPLICATION <br /> 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 /> PROJECT SITE.:INFORMATION <br /> PROJECT�J,T��DDj;2)§:ate a PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ligadakaattgaMiggREMER:lettgagnaniggitcrAqviNFoRmAttoN> _.<. ,., <br /> OWNER NAME: TENANT NAME(If Commercial): r qn, o <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: sow Fire?ro+eLkow hAths,7.nc <br /> CONTRACTOR ADDRESS: STREET 'c. 13 a,o 1 fit(D <br /> CITY Era.RLte Ra STATE VIA ZIP ft <br /> g�$a <br /> CONTRACTOR PHONE: t -30 7t4 CONTRACTOR EMAIL: Ilton QburNb Fire ,CA Mr <br /> CONTRACTOR LICENSE#(REQUIRED):w#SulitiOff 8N WIA, CITY OF EVERETT BUSINESS LiCENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ,0'CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425--345.-0.LI13 <br /> 910N Sn,tg CONTACT EMAIL: l71OriQicurio Fin .e..r4 <br /> BUILDIN. GSPERMIT APPLICATION, <br /> Existing Use of Building: IA/artiumst 47Prict 5 jaGe Contract Price of Work:$ — <br /> Proposed Use of Building: Wt reivOwsr/oFRzcv 'pier Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial El Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair .BT.I. ❑Sign ,EPSprinkler ID Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: AAA wr,v Kter Goverpte tb -th.e '(er fsfkry FF,g4 litsiots of tke wal►oak stmt.( <br /> eFF of II.e t.letsivio II✓t+ Pet spri►Kkr soil L" <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 5 trots 1659 C ktlI ,E knot, stoat rest ooK <br /> t.MECHANICAL PERMIT APPLICATION,;:,,, PLUMBING.PERMIT APPLICATION_ c, <br /> Type of Project: _New_ Addn Alteration Repair Type of Project: New Addn Alteration Repair <br /> #of #of #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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 /> iattiA#RignEjt I SUPPRESS ON AIM <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 circumstance.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAG. <br /> City of Everett Official Use Only <br /> � <br /> CA) T un., 713117 PERM 11o1 O I <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />