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OLTPERMIT APPLICATI• <br /> BUILDINOPMECHANICAL/ PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1. FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: <br /> 19 2 5 i(F S i PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> �4i( ,1„� CONTACT INFORMATION <br /> OWNER NAME EC-410 S S TENANT rymE(If Commercial): .X6-7) CADS, 5 <br /> OWNER MAILING ADDRESS: STREET 1.9 Z S 2_<.„, S 1 CUD' ' 4 I _ 1/t s(Q <br /> 'CITY EVE g_CT/T STATE \/4 A ZIP <br /> OWNER PHONE: V25.- 7'/ —09-3 / (7 OWNER EMAIL: <br /> CONTRACTOR NAME: -T/VE-{tSQURCC c ] - 1YICG S I- LC. <br /> CONTRACTOR ADDRESS: STREET "1/G.3 Si G- c4i/vc-7 /2_ D <br /> CITY SC J,71/v 6-1F STATE 01/T ZIP 9R320 <br /> CONTRACTOR PHONE: 945.--576,--(-1fj CONTRACTOR EMAIL: ��c--y, ,4 XAi-/1k€ PSC'•CoA <br /> CONTRACTOR LICENSE#(REQUIRED):... VC LA,S.. gJ/e 9... CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ac/9B <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: G/ZS -S%(o - 413 c Q <br /> ,/-zL ` /1 L-0,X.,¢f/vim 2 CONTACT EMAIL: <br /> t BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ /G6c-.), C CJ <br /> Proposed Use of Building: Heat Source: 'Gas ❑Electric ❑Other <br /> Building Type: OBER-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> l/ war <br /> __ , VS <br /> ,4 PO r",67C r a,rf/ "3 D tic" to e--#7 c—T�l� - C 0 CA,' -" <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 #0f 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/SUPPRESSION SYSTEM <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 lam authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> `f� L Zy/& PERMIT# /1 I(po ' '17 <br /> Owner/Auth rize Agent Sign ture Date (Revised 10/12/2015) <br />