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P <br /> BUILDING /MECHANICALS PLUMBING I SIGN 1 UPRINKLER/DEMOLITION <br /> /1111 - <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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 210'S Ailek1L1S. ts' -nut PROPERTY TAX#: 00401544 300102 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: A„,kn,,,A WAt EL TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3 i/S I In rt. WE. <br /> CITY wlArjh"SVM , STATE e./A ZIP 4%111 <br /> OWNER PHONE: Igo 01. win OWNER EMAIL: AMANIcAS a WAALL.Gay% <br /> CONTRACTOR NAME: tub. kutrilyis egai 1V& "iivt .10 <br /> CONTRACTOR ADDRESS: STREET <br /> CITY 1.Gv v1/46-adi - STATE W.`l ZIP <br /> CONTRACTOR PHONE: � /e /� CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): C A ,' T'Jeze V t e R CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):03 ei <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR OTHER(Please Specify) Awl lWE' <br /> CONTACT NAME: CONTACT PHONE: 706,,q31, 610% <br /> C7 Aq.0.4 SCA 11C.. CONTACT EMAIL: co LINA a Mara iuow a+PE 'tf•cowl <br /> BUILDING PERMIT APPLICATION <br /> E�isting Use of Building: INat1.V. '� .ttt 1 IRIES, Contract Price of Work:$ 15 •60 <br /> Proposed Use of Building: 51Ng1Z i=UWttt,'{ ges. Heat Source: ❑Gas ❑Electric CI Other <br /> Building Type: VISFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition VRemodel ❑Repair ❑T.I. ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> AblvutTitt,41 ittkvAstivet. txttft. usO pts S►K►SLg-*nvt,tiv'`1 tetAtsivoc.t .to >IN&LAM wit. / <br /> Lt + 51.E S �kJS w/ •J come) eta ixt- /41•44ix kz-buE'.$ <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 ;lAddn Alteration Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump 'j Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater I Bathtub Urinal <br /> 1 Gas Piping 1 Boiler 3 Lavatory(Wash Basin) Drinking Fountain <br /> ( Water Heater Refrigeration 1 Shower 1 Floor Drain <br /> l Gas Fireplace Wood Stove<; I Kitchen Sink&Disposal Grease Trap <br /> 1 Gas Range Ducting 1 Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> 1 Range Hood '�� y Other: <br /> 3 Exhaust Fan Sink(Service/Bar/Mop/etc.) 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.f 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 /> City of Everett Official Use Only <br /> PERMIT 0 b oO2 <br /> ,j <br /> ,00Dwner U�orrized Agent Signature Date (Revise. 9✓'• 016) <br /> 1YAIli S X s pet u to t lel j lei1-i r`P.w ot-j0l2a?si c 't , <br />