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,IP,44/e--_,...A. PERMIT APPLICATIOI'- <br /> 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) . . , ; PROJECT,SITE INFORMATION, ,, , , , <br /> PROJECT SITE ADDRESS: 0 Z a 1 (A S f___ Q6q�( PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION , <br /> OWNER NAME: G (,(._•,, lino? TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET )CZ0t 15 kap S <br /> CITY €oe('C ` STATE UJ ' ZIP q e 2.e3 O <br /> OWNER PHONE LI ZS— -1,6K/'Z D' OWNER EMAIL: D U J ) (e model t n 1 C Gym <br /> CONTRACTOR NAME: �Qc— ir)We� r\--)(CC ISji--, r 1Lv rpock l j( Q, L ( - --top <br /> CONTRACTOR ADDRESS: STREET ')( I-y4Q 05 DAD 0\J'C—, <br /> /I <br /> CITY / STATE ZIP <br /> le r/ <br /> CONTRACTOR PHONE: 0 YY`2_ s� CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): '` p�Oc cr'. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) <br /> PRIMARY CONTACT: l DOWNER 0 CONTRACTOR 0 OTHER(Please Specify) ��Qc,,� <br /> CONTACT NAME: CONTACT PHONE: q2, — - QR_Z - �— <br /> '6L () CONTACT EMAIL: ` <br /> r upee (1Clt e i ng. P S((YII 1•Com <br /> BUILDING'.PERMIT APPLICATION' C <br /> ea <br /> Existing Use of Building: -FT._ Contract Price of Work:$ 2.1)IZCO <br /> Proposed Use of Building: ' • V-- Heat Source: ❑Gas I4lactric ❑Other <br /> Building Type: 5iSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New j2addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WOJIASL <br /> CCnel-� \ a� i hvAn\ S Q(Q . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> ..... ......... .............. . .... ... .. .. .. . <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 /> NC—Air Handling Units Heat Pump ? Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Z Lavatory(Wash Basin) Drinking Fountain <br /> I Water Heater Refrigeration I 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 I 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 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 Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> -.ma Aillir ' --.� GHBI,- 6O 1 <br /> Owner/Au"gent Signature Date (Revised 5/20/2016) <br /> ciL <br /> Zf'` <br />