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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER I DEMOLITION <br /> �'1 � CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 j(E)everetteps@everettwa.gov J www.everettwa.gov/permits <br /> (Bl air Bradt Ink se}, _ ,,. .P ECT 0-ri i 1, <br /> PROJECT SITE ADDRESS:a��/ 00 Yd i so4 V DE`,201 PROPERTY TAX#:004438413 to&OO/d 0 <br /> PI it/' l s 0 <br /> LEGAL for new construction: Short Plat/subdivision EV emi, Lot No.!3.`t (attach copy of long legal description) <br /> 00NTACT INF+tdiRMA '1tiN n - <br /> OWNER NAME:/rekti ThuG/a S?mac rTENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /S.3/ 'VI f1 ems, v`'& <br /> CITY ✓F vere , /�, tsSTATE Wit ZIP 7&,2i ) J <br /> OWNER PHONE: 9'7.5;3/f 95;47f OWNER EMAIL: reiFj1-GcG•4iS Crl�ldtI //� <br /> J <br /> CONTRACTOR NAME: ACdrp t c7 -cam€ :7i-.2-r... <br /> '2 - . "--)4•C <br /> CONTRACTOR ADDRESS: STREET P i 3 ')< /O G�3 �/ 7/J <br /> CIN g/al)", i vier STATE AVJA �C ZIP 9O 06 G�-• <br /> CONTRACTOR PHONE: 2(P4 `" 3 (--- �9/!f CONTRACTOR EMAIL: o£r! 2 h of V `f e-�2z StN4 ,j .,/G�°-1 <br /> CONTRACTOR LICENSE#(REQUIRED):N PR eel !cyO/f+ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):1-778 <br /> PRIMARY CONTACT:%OWNER D CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:- CONTACT PHONE: G74., '"3 f ?b"--,%.29 <br /> / t1kq CONTACT EMAIL: ice �-tze i 7 4' <br /> t 5& J 'o— <br /> f- <br /> .., ±-::` tWiGR»lllG':OItfi-APPtIOA'1fOI+t ,;_ .,1- N rY',t ,,,►/ 1 ?,,T-:.-5::--c- <br /> Existing <br /> T -5. <br /> Existing Use of Building: 5i ,j �O)'hi`ff Pe51•Zi%_ Contract Price of Work:$ '' , o24-- "i✓. a. * 1., 4 J4 1 <br /> Proposed Use of Building:ad of AP a-r r Heat Source: $Gas DElectric ❑Other - , ) <br /> Building Type: ,, FR-Detached FR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial il Industrial <br /> Type of Project: ❑New ❑Addition ,emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION, #t� OF WORK: - <br /> (}"� <br /> ead,/ 6G-Seifle4- /o I^ A Dfi� .�fr1 e 4 <br /> Ice-WI /Ti e4- <br /> / ` <br /> 1-1 <br /> 7L mss V 7 <br /> . . Sem , <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ,. <br /> MECHANICAL PERMIT APPLICATION' '.,` - PLUMBING'PERMIT 11PPU rATIOMI <br /> Type of Project: _New _ Addn _Alteration Repair Type of Project: _New Addn Alteration •air <br /> #of List of Fixtures #of List of Fi, res #of List of Fixtures #of " of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat P. p Toilet Bac ow Preventer(Inside Bldg) <br /> Forced Air Systems U.' Heater Bathtub - nal <br /> Gas Piping =oiler Lavatory(Wash Basin) Dri tg Fountain <br /> Water Heater Refrigerati Shower Flo• .in <br /> Gas Fireplace Wood Stove Kitchen Sink&DisposalGreer•.Trap <br /> Gas Range Ducting Dishwasher '1• Drains <br /> Clothes Dryer Hooku a- Other: Clothes Washer. / Medical Gas <br /> Range Hood Water Heat \--1 Other: <br /> Exhaust Fan \f 7 Sink S: 'ce/Bar/Mop/etc. Other: <br /> 'SPRJN .0. it f SUPPRESSION 51 S TEM;.`. <br /> ICh: ical or Water 1 No.of Heads <br /> ACKNOWL r'GEMENT:l 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 fe•eral,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 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and I comp! with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> / /ig PE # <br /> Intal '0O2--- <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) �� <br />