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OP.' PERMIT APPLICATION <br /> BUILDING I MECHANICAL/ PLUMBING/SIGN / SPRINKLER I DEMOLITION <br /> ✓'`ir " CITY OF EVERETT PERMIT SERVICES <br /> cri <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)overetteps@everettwa.gov I www.everettwagovfpermifs <br /> (Blue or Black Ink Only Please) -PROJECT•SITE INFORMATIoN = <br /> PROJECT SITE ADDRESS: , <br /> LEGAL for new construction: Short Plat/subdivislon PROPERTY TAX#; <br /> Lot No. (attach copy of long legal description) <br /> CONTACT'INFORMATION <br /> OWNER NAME: <br /> IP Y"et 5 <br /> nTENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STRSE- )#..'I 3rd — -. <br /> CIN <br /> STATE M` zip 11v+ <br /> • C <br /> wK,3-- <br /> OWNER PHONE:+. ,. <br /> k OWNER EMAIL: <br /> CONTRACTOR NAME: �' ("I bi C ,p ` _ <br /> CONTRACTOR ADDRESS: sraEET I 4� C'rOrx.CIUL9 <br /> crry G,✓`C.A c+4./V 4. STATE - ZIP q g‘Z,0 I <br /> CONTRACTOR PHONE: L. �Q 0 <br /> 0 CONTRACTOR EMAIL• '•r tit -s A / flC .CD <br /> GE3NTRACTt<7Fi-LICENSE#(aEQUIR!'[3: "�` (915R-4---- � +I , - <br /> `►"" DtTY OF EVERETT SUStNESS LICENSE#(REQUIRED):104,q <br /> gr <br /> PRIMARY CONTACT: 0 OWNER (CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> Datolo La, <br /> CONTACT PHONE: � �,Z5 25 G1 0�5 <br /> �`'1 <br /> t ✓ <br /> CONTACT EMAIL:�- f a e exvt,keGL ,Co rvi <br /> 'BUIILD ING=PERMIT'APPU;ItIATION ,,;� "'- _ <br /> Existing Use of Build(ri : <br /> Contract Price of Work: $_" <br /> Proposed Use of Buildin+: <br /> Heat Source: as ❑Electric ❑Other <br /> Buifi in .Type: PFR—Detached ❑SFR-Attached ODuP v4. <br /> a ❑Multi-Farnil -#o Units: ❑Commercial ❑Industrial <br /> Type of Project, ❑New ❑Addition ❑Remodel OReair DTI OSI n []Sprinkler ❑Demolition ❑Chan,e of Use <br /> DESCRIPTION OF WORK: <br /> Kepaa_90—S <br /> ASSOC#ATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL:P-571 IT APPLICATION <br /> Type of Project: New _ Addn 'l-UMBING'' a t� AI?PGT ATIE1tN <br /> _Alteration _Repair Type of Project: New Addn <br /> #of #of Alteration Repair <br /> - „auras _____!1s t QfEktUtes -L1ct fFixturas -- #01 <br /> Ft7t7ifres L ls{o%JkKes <br /> #of <br /> A1C—Air Hartdlirtg Uni#s Heaf Pum Ixtuirrs Fixtur — -"-"USI of Ftzlures- <br /> ( <br /> es <br /> Forced Air Systems t 1-- <br /> Urinal w Preventer Inside 13id. <br /> Jntt Heater 8afhtub <br /> Gas Piping por(er ..Urinal <br /> Water Heater Lavatc (Wash Basin) Drinking Fountain <br /> Gas FiHeale.. Refrigeration Shower <br /> Wood Stove Ficor Drain <br /> _._._....,______--"—Clothes <br /> Ran e Durt Kitchen Sink&Dissosal Grease Tra; <br /> Clothes Dryor Foo Dishwasher Roof Drains <br /> Ran e Hood Other. Clothes Washer <br /> MedicalGas <br /> Exhaust Fan tlVater Heater 'Other.r: <br /> Sink(Service/Bar/Mo /etc,) Other: <br /> SPRINKLER-SUPPRESSION SYSTEM ' <br /> Chemical or Water Ne,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,Building Official state,and local law. Tne <br /> being authorized under agny circumstance.tt I athe owner,or am authorized bytthe owner of this property to performauthorizes approved work and no devations therefrom,Deviations must stheeauthorized wok for which n wopIc from the <br /> and I comply with the State Contractors Law 15.27 RCW and 296.200A WAG, <br /> Ch application is made. <br /> City of Everett Official Use Only <br /> } _-G/.i 1PERMITrYO _ <br /> Ow,erlAuthortzedA 9e' Signa#ure �� <br /> Signature Date <br /> ('Revised 9/23/2016) <br />