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• • <br /> £{� .�. ..°°x.<<,.,�. PERMIT APPLICATION <br /> 4 , V-4 4 -:` BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> �r,,, ,* ; 1 CITY OF EVERETT PERMIT SERVICES <br /> os L cu�;M— 3200 CEDAR STREET,EVERETT,WA 98201 <br /> . 7 ,.4y)425-257-8810 I FAX 425-257-8857 I(E)everettes@everettwa.gov I www.everettwa.gov/permits <br /> „241 <br /> k6Lahtie or Black lr Only Please) PROJECT SITE I FORMATION. <br /> 11PRO JECT SITE ADDRESS:, >Cr)- `i ' 4v. . � .-.5-7 PROPERTY TAX#:250 10,00 0 700 <br /> j a �t®� <br /> 'I_.f+��AL.for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) ` <br /> CONTACT Ih\€FORMATOihl <br /> li <br /> II L tfs/ 'ER NAME: ,Ef/4€ / /<L4j -- 11 TENANT NAME(If Commercial): <br /> tlOWNERMAILINGADDRESS: STREET /2,6,S /3o ' A7. .Se. A <br /> II CITY /e--1 (/ // STATE bt if- ZIP /f' oce <br /> liOWNER PHONE: 42$ -_5-v/^ G'Vic-/ OWNER EMAIL: <br /> IICOH T RACTOR NAME: 5'e /i Gam! ,D���f % ,o77 jO,/ GG C <br /> 1�COi'i RAC 6 OR ADDRESS: STREET (( ( /330 £r' se 4 " I /� <br /> li_.....___...-._ CITY C-///���/2-1.�/��- STATE aq--- ZIP?<So c <br /> �i <br /> 11CON T RACTOR PHONE: 2,,r-- r -6 cc-/ CONTRACTOR EMAIL: 5 D c/ i&/ CS 0Givet., CC/I <br /> ir— <br /> IICONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> 'iliPRIIIIIARY CONTACT: DR[OWNER ®-CONTRACTOR AZ OTHER(Please Specify) /}pit/ Offal(0 0 6 <br /> r-- NAME: CONTACT PHONE: - 93 <br /> f;:t:`�?e T e�.CT l't,Alc!E: �6 I ,S "2�-/ L. <br /> -/fiyt i G - CONTACT EMAIL: /f C• } ` C f��/i'�/L, c o /-r <br /> E �� :BUILDING_PERMIT APPLICATION <br /> jExisting Use of Building: — Contract Price of Work:$ <br /> (Proposed Use of Building: t2.2- $h5NT$ Heat Source: WGas DElectric ❑Other <br /> I:. <br /> %Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex EfMulti-Family-#of Units: 13 DCommercial ❑Industrial <br /> )Type of Project: ligNew DAddition DRemodel ❑Repair DT.I. DSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> liD€ESCRiPTION OF WORK: - ^ <br /> 1 �:f761- -7 7L)'Ai G S�,- <br /> D of 1-4-4-1 6 U� �/A.—C.7 4r G�Le�-46 <br /> ii 1 , <br /> NASSOCIATED BUILDING PERMIT#(if applicable): <br /> s <br /> I MECHANICAL-PERMIT rn�� s Aq <br /> ICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> r —. <br /> trpa of Project:)A New _ Addn _Alteration _Repair Type of Project: 1;, .New Addn _Alteration _Repair <br /> #of #of #of #of <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures ' Fixtures <br /> I - IAiC-Air Handling Units Heat Pump - 33r Toilet Backflow Preventer(Inside Bldg) <br /> li Forced Air Systems Unit Heater �, Bathtub Urinal <br /> a •I�_ Gas Piping Boiler 3 Lavatory(Wash Basin) Drinking Fountain <br /> H I Water Heater —Refrigeration _ Shower Floor Drain <br /> T -, !Gas Fireplace - Wood Stove - Kitchen Sink&Disposal Grease Trap <br /> II_ —Gas Range Ducting _ [,Dishwasher Roof Drains <br /> frT Clothes Dryer Hookups Other: C_Clothes Washer Medical Gas <br /> 1 1 Range Hood - ^ Water Heater Other: <br /> j. <br /> ;Exhaust Fan --- !Sink(Service/Bar/Mop/etc.) Other: <br /> ji <br /> il SPRINKLER/SUPPRESSION SYSTEM <br /> yj 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 /> • <br /> / / PERMIT#al l —( <br /> t wner/Authorized Agent Signature /Da e (Revised 9/23/2016) <br /> 1� <br />