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PERMIT APPLICATIOIII <br /> BUILDINaECHANICAL/ PLUMBING/SIGN • �RINKLER/ 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 I www.everettwa.gov/permits <br /> Blue4r+Black.,fnkrOlnlyPlease);., ,.,,, ..< 1f _'PROJECTSITEINFORMATION <br /> PROJECT SITE ADDRESS: . 7 t7.--• 6,01.41,1 AAK&A iTOPERTY TAX#: 00,4-''911t G,/„14r0 ....6(;)ell <br /> LEGAL for new construction: Short Plat/subdivision ��� IP Lot N h co of lon le al descri tion `� <br /> F " I ` 4 . BONTAc T INFORMATION <br /> OWNER NAME: J V-{4-4=7 I 1,4,..-G TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2/ 2.— <br /> CAS •� / <br /> CITY "' �/�►"�Y/� STATE v41,6„... `�� ZIP ,E,2.10( <br /> OWNER PHONE: OWNER EMAIL: .,� t(l=b�� e C7l` . C_,{ <br /> CONTRACTOR NAME: (� <br /> ‘ c,&. <br /> -,:C a____ ,-- (j) c O2 co4c'.;• <br /> CONTRACTOR ADDRESS: STREET To 5S LA Alw <br /> CITY LIAMINWOCCO STATE D ZIPl�r - <br /> CONTRACTOR PHONE: (.4 2e25 "l'4 I Sq.30 CONTRACTOR EMAIL: tijr3Q. et I -pKA, !! OF tl <br /> CONTRACTOR LICENSE#(REQUIRED) QQS py,pi..1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRE' LA 4 o <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 42 :!97/-1'.---!--.-� (Q� usCONTACT EMAIL: }/t ✓j(yietCioN, A.12.41/t Cf 't/1A-6.Cs c. <br /> - -BUILDING PERMIT APPLIcATIOM <br /> � <br /> Existing Use of Building: Contract Price of Work:$ I, 7,�O. <br /> Proposed Use of Building: r xatAiLsiseAL-e-40A. , Heat Source: ❑Gas 0 ectri ❑Ot r <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: om rcial ❑Industrial <br /> Type of Project: ❑New ❑Addition E2emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ,----- 1 —,---zAtk.tr 4 <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 _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 SUPPRESSIO1N SYSTEM' <br /> Chemical or Water I No.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 lam 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 WAC. <br /> / Alb klCity of Everett Official Use Only <br /> A, lir PE' I # (gOS 03 <br /> 5 <br /> Owner/Author'e. Age, Signature Date (Revised 9/23/2016) <br /> V <br />