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PERMIT APPLICATION <br /> M. <br /> BUILDING I MECHANICAL I PLUMBING I SIGN 1 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 1(E)everetteps@everettwa.gov J www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:� A` �'j <br /> a.(�l I }»y 1 JE PROPERTY TAX#:WA 51L10l J 62OO <br /> LEGAL for new construction: Short Plat/subdivision _Lot No. (attach copy of long legal description) <br /> . j CONTACT INFORMATION <br /> OWNER NAMFz �nfi f c1 "+ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srREEr??�Q/1 r[[X (+'V Roe --- <br /> cmT, i,. ` e,BA STATE s tX <br /> l.� s� ziv 4 <br /> OWNER PHONE: r VI ASS all J OWNER EMAiL:: <br /> CONTRACTOR NAME: W+r$ i i) i77 Li ilk�9--TT-IZ- l�it r Grc,.s • <br /> CONTRACTOR ADDRESS: smear i—l(5 . (l I r 411" r t 56 — P6 190x 5-92bS1 <br /> cnr R- r i-rih STATE (Ai+ W-1) 461 <br /> CONTRACTOR PHONE: Zy-- 21P <br /> 047 (g7/ !CONTRACTOR EMAIL: (J -(,J -HV .0 6IK19Ito (Ofr ) <br /> CONTRACTOR LICENSE#(REQUIRED): ri( * .E4"fZ"jif) lorry OF EVERETT BUSINESS LICENSE#(REQUIRE); <br /> PRIMARY CONTACT: 0 OWNER [CONTRACTOR 0 OTHER(Please Specify) �� <br /> CONTACT NAME*1I CONTACT PHONE: 2.. -gg3-WI 7/ <br /> V r DLni- is CONTACT EMAIL: jt.,tf iliej- 4/.,@64 -1L,u k <br /> V � <br /> L <br /> ,BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of rk: $ Il L,0.-Ce — <br /> Proposed Use of Building: Heat Source: s OElectric ©Other _ _ Y <br /> Building Type: J d © <br /> FR-DetacheSFR-Attached ❑Duplex ❑Multi-Family4of Units: C3 Commercial [Indus ' __ <br /> Type of Project: ©New DAddition ❑Remodel 0 Repair CIT.I. [Sign ❑Sprinkler ciDemolition ©Change of Us riplaki444 <br /> DESCRIPTION/ OFOFWORK:� <br /> / e Ell//-e... Qf- / '-LI gai 94r } +- <br /> ASSOCIATED BUILDING PERMIT# pplt <br /> if applicable): <br /> ( cable): <br /> MECHANICAL PERMIT APPLICATION \ PLUMBING PERMIT APPLICATION ! , <br /> Type of Project: New Addn Alteration �Repai ,...f.. Type of Project: _New ,Addn Alteration Repair �r ._J <br /> #of #of <br /> Fixtures List of r=fixtures List of Fixtures #of List of Fixtures <br /> Fixtures 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 <br /> Gas PipingBoiler Urinal <br /> IWater p fer Lavatory(Wash Basin) Drinking Fountain <br /> Refrigeration v Shower Floor Drain <br /> 'Gas Fireplace Wood Stove Kitchen Sink R.Disposal Grease Trap <br /> _Gas Range other: <br /> Dishwasher <br /> Clothes Dryer Hookups Other: Medi Drains <br /> Range Hood Clothes Washer Medical Gas <br /> Exhaust Fan Water Heater Other: <br /> Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> .,�� !Number of Heads <br /> ACKNOWLEDGEMENT;I have reviewed this application and confirm the r <br /> mation 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,Cr)am authorized try the owner of this property to perform the work for which application is made, <br /> and!comply with the State Contractors Law 18.27 R and 290.200A 1,141C. <br /> ( � •C� City of Everett Official use Only <br /> \J`�'� 'I • / PERMIT <br /> ierlAetthorized Agent Signature I / I D3--��� <br /> 9 <br /> Date (Revised 5/20II2016) <br />