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PERMIT APPLICATION <br /> BUILDIN��CHANICAL/PLUMBING /SIGN"I'I''eI=RIRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIt7LU <br /> vitt 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: CIS ram s* ( dehej' PROPERTY TAX#: zios-8onza 41060 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: e-of Everett TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1205 eptkeYstrzan LLIty Suit__21,0 <br /> CITY EverettSTATE � ZIP 14' / <br /> OWNER PHONE: it „S`—ZS"? 3i4,41t tag <br /> EMAIL: <br /> CONTRACTOR NAME: Tarr u(r ,/)7il <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: �^ CONTRACTOR EMAIL: <br /> ('U <br /> CONTRACTOR LICENSE#(REQUIRED) t2-I(j 61-- 333/(. -a CITY OF EVERETT BUSINESS LICENSE#(REQUIRE0):053a <br /> PRIMARY CONTACT: tiKOWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: t{25_38 _1X,(3 <br /> aiplitdeon WitlY r CONTACT EMAIL: 1„,,,)hitedcerostrartenreveet.k.Gjm <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$446044261 ©UC) <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: OSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: Jew ❑Addition ❑Remodel ❑Repair 01.1. ❑Sign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: xA o •-ipiGniL Scrci�sorudaJ.P..d aiiy! Carte/ - ;06444 <br /> Prehnettol %n 4he ettiatchod AAget . Cane 104W-way ebed *mai enctb u"f- alLoo pa '°lf prJec: <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 #°f List of Fixtures List of Fixtures #°f List of Fixtures #°f 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.I am the owner,or 1 am authorized by the owner of this properly 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#ict-leo ✓(100 -010 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) t <br />