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'IPPERMIT APPLICATIOII <br /> BUILDING 1 MECHANICAL/PLUMBING I SIGN I SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERE I I,WA 98201 <br /> (P)425-257-8810 l FAX 425-257-8857 I(E)everetteps@everettwa.gov j www.everettwagov/permits <br /> (Blue or Black ink Only Please) <br /> �l _ PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 300 I ;E kT EM Aii C PROPERTY TAX#: Z 9 052 0004-09900 <br /> LEGAL for new constwction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> i .CONTACT INFORMATION <br /> OWNER NAME: f r) R �t v TENANT NAME(If Commercial):&LQ grv,DY,J / (j `3 <br /> OWNER MAILING ADDRESS: STREET 2 e/ g�(tW C k.--- <br /> (.[ <br /> CITY C'-/�-(�b / STATE Uhl .ZIP 9 824 ( <br /> OWNER PHONE: 4Z j c— 9 3 3 k OWNER EMAIL: f/l y reen 6)4(e.04 to 01- <br /> CONTRACTOR <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LiCENSE#(REQUIRED): CITY OF EVERETTBUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR AoTHER(Please Specify) %ENANT <br /> CONTACT NAME: > xityh Est` CONTACT PHONE: L--;•� , g 9, 3 4 3 7 <br /> CONTACT EMAIL: l n b pr:,t c 'L,;,.mi'': trO�t <br /> BUILDING PERMIT APPLICATION C1l <br /> Existing Use of Building: Aer 572,b10 Contract Price of Work:$ (( 400 C <br /> Proposed Use of Building: Ef714/L Heat Source: &Gas C3Electric DOther <br /> Building Type: ❑SFR-Detached E1SFR_Attached El Duplex ❑Multi-Family-#of Units: 781Commercial )]Industrial <br /> Type of Project: ONew DAddition 0 Remodel DRepair 1JT.I. OSign DSprinkler ODemolition %Change of Use <br /> DESCRIPTION OF WORK: 2 �X �� `� � � �� � <br /> CO/JVC?t! 1S""7fj/(r 4E7— 6 71V!a 4g� (f <br /> 6L453 S/ P. ,41O 6,74iCTZJP?4 .- / /D/Pf &. .5-. <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 /> #ofFixtures #of #of #of <br /> List of FFixtures Fixtures J^iittttixtures List of Fixtures List of Fixtures List of Fixtures <br /> res <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(ServicelBarlMopletc.) Other: <br /> SPRINKLER I SUPPRESSION 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,ort am authorized by the owner of this property to performthe work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMITA0 821 <br /> ql'i-A9L-- 2'----- /23/2-0(7 <br /> Qwner/Authorized Ag nt Signature Date (Revised 9 3/2016) <br />