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PERMIT APPLICATION <br /> ee/S/I"*/—A, z--"It BUILDING/ MECHANICAL/ 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 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) 1O.2, PROJECT SITE INFORMATION j <br /> PROJECT SITE ADDRESS: tA"., — 44 PROPERTY TAX#: (6i437Q 79�y 06 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: No,,A d- .t`'Sy _ \A-,J d.SitisN TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 50-I k,L ss0,- QQG.C.� (`D Q <br /> CITY —TO AL;p i (, ��}J ' STATE L-)4 ZIP /V 2 7 <br /> OWNER PHONE: ( LO(o) 32I ' IIS( OWNER EMAIL: VA-A.sv.I, vr.S -sf - i 5",_,,, <br /> "�`�i <br /> CONTRACTOR NAME: C.3rotru� C.sx\ 1v�c i_o- iI �J <br /> CONTRACTOR ADDRESS: STREET 21 SI_g (`t',1/4-. S Se <br /> 5'82:72, <br /> CITY Ov ee-.t(.-% STATE b--)Pr ZIP <br /> CONTRACTOR PHONE: 42,5--•?-. N tJ <br /> " `��f07 CONTRACTOR EMAIL: CSW (LOC...-- I , (ftv ti <br /> CONTRACTOR LICENSE#(REQUIRED): i'Oe- C(„ 002. L..5 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):1 5.t l9, <br /> PRIMARY CONTACT: 0 OWNER \ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L12 S 314' 1 yoci <br /> Cott-- 0-006\-) CONTACT EMAIL: j„,)‘,.. (-0:_2. ..._._.t-) <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ ' /Cz+ <br /> Proposed Use of Building: Heat Source: Was DElectric DOther <br /> Building Type: DSFR-Detached DSFR-Attached *Duplex DMulti-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project:'':lew DAddition ❑Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler DDemolition OChange of Use <br /> DESCRIPTION OF WORK: C04" uC"Ir eg\ DU 0 . <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 #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Co. Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater to Bathtub Urinal <br /> 2 Gas Piping ,, s iler Lavatory(Wash Basin) Drinking Fountain <br /> 2., Water Heater v A. ` ra.6• to Shower Floor Drain <br /> Gas Fireplace Wood Stove 'L Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> 2. Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood �../77`Wa t Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/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,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Con actors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> J -------- ,--- ; (___ I PERMIT#e i&t1/4)1_to5 <br /> Owner/Aut rized nt ignature Date (Revised 9/23/2016) l r <br />