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• PERMIT APPLICATION • <br /> ,�.• BUILDING /MECHANICAL I PLUMBING !SIGN/SPRINKLER I DEMOLITION <br /> k ol <br /> lw ,,, It. 1`I_ CITY OF EVERETT PERMIT SERVICES <br /> a te ��, 3200 CEDAR STREET,EVERETT,WA 98201 <br /> e /,,f jF)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> )�� grige_ou Mack link Only Please) _ PROJECT' SITE INFORMATION <br /> RMATION <br /> �PROJECT S136 r. ' '4V� t. 9�wf PROPERTY TAX#:?p ) IZPLO 700 <br /> tI.saaAL �(for new construction: Short Plat/subdivision Lot No. ! / (attach copy of long legal description) t / 2&Dt <br /> l CONTACT I) FOR ATIOii9 .'. <br /> I;OWNER NAME: e-� 7 [/Lyf f TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /205— /307 .c.,-. „Se- A <br /> Ij CITY V 72..( -/ // STATE VV 4Ir ZIP /�2 f)CF <br /> "•I OWNER PHONE: 42,j 5-v/ - -/ OWNER EMAIL: <br /> Il CONTRACTOR NAME: 5 t�r- (9 .��r��� 1,Gt (/7- ,q 077�/O A/ GG C <br /> i;CONTRACT OR ADDRESS: STREET (/O.5 /, o a cgr` -•�f ,,,ie 4- <br /> 1 CITY /972-t 7-1--- STATE t///'11--- ZIP?cr.C2-0P <br /> SCONTRACTOR PHONE: �2.J-5V lc-//' —6.- CONTRACTOR EMAIL: 5 D V/MCS .0 ec,„ G, C <br /> .ICONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> !•PRIMARY CONTACT: La OWNER ®.CONTRACTOR OTHER(Please Specify) 4 rylJ IJ U' D 6 <br /> rr -- 955 --2�-/ 2 <br /> •i%,Ol�NT9a.CT NAME: /� CONTACT PHONE: �b <br /> !i• '{f/y� (/G B"/1 CONTACT E MAIL if-C, C's`f np77Y . c6 t`f <br /> P. BUILDING PERMIT'APPLICATiONE <br /> jExisting Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: 12 Z -442 `i M W47-5 Heat Source: 17 Bas ❑Electric ❑Other <br /> ,Building Type: OSFR-Detached ❑SFR-Attached ❑Duplex EiMulti-Family-#of Units: 15 ❑Commercial 0 Industrial <br /> Type of Project: gNew DAddition ❑Remodel ❑Repair DTI. OSign ❑Sprinkler ODemolition ❑Change of Use <br /> 11 <br /> iDESCRIPTION OF WORK: -. . <br /> op <br /> Co 7 71-4/..-",A/ G s e. <br /> J Uz-{ wd..7 6,6% )0 ti.,/4.'Z7> 4 , <br /> II <br /> iASSOCIATED BUILDING PERMIT#(if applicable): __ <br /> t PAECiI.MMiCA q PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project:K New Addn Alteration Repair Type of Project: V—New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> it Fixtures Fixtures Fixtures Fixtures <br /> 1-- A/C-Air Handling Units Heat Pump - 3 Toilet Backflow Preventer(Inside Bldg) <br /> � Forced Air Systems ¢ ' Unit Heater ., Bathtub Urinal <br /> p Gas Piping // _Boiler 3 Lavatory(Wash Basin) Drinking Fountain <br /> li i Water Heater Refrigeration _ Shower Floor Drain <br /> -. Gas Fireplace - Wood Stove • Kitchen Sink&Disposal Grease Trap <br /> - <br /> ti .-. Gas Range Ducting _ I Dishwasher Roof Drains <br /> 1- t IClothes Dryer Hookups Other: i Clothes Washer Medical Gas <br /> - I Range Hood - Water Heater Other: <br /> I. G. Exhaust Fan — Sink(Service/Bar/Mop/etc.) Other: <br /> t it_e _ <br /> u-. SPERR VILER/SUPPRESSION SYSTEM <br /> r3 Number of Heads _ _ <br /> _—y <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.1 am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 7utiA <br /> Owner/Authorized Agent Signature /Da e <br /> g (Revised 9/23/2016) <br />