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• PERMIT APPLICATION• <br /> c"� BUILDING/MECHANICAL I PLUM SING 1 SIGN/SPRINKLER I DEMOLITION <br /> ltx CITY OF EVERETT PERMIT SERVICES <br /> � <br /> 4I + >! - 3200 CEDAR STREET,EVERETT,WA 98201 <br /> .A� fK 7 (df i io,mi1)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> .�.+� .�._ - <br /> '(E3Eaitie©r Mack Irak Only Please) PROJECT SITE INFORMATION <br /> uIl� �- o Q S� PROPERTY TAX#:gp(9�I .CC) 700 <br /> ,���°OsECT stTE A�DREss:,v3, � �'� (,��'7 <br /> I?LEGAL for new construction: Short Plat/subdivision Lot No. tip (attach copy of long legal description) it I <br /> 'i CONTACT 9NFORMATIO <br /> �I _-�--_-- _-.-- �--A= -/� 'i�Ea�4,#�dT NAME(If Commercial): <br /> ,OWNER NAME: '/�.l 1` /G1�� �J /j <br /> ;OWNER MAILING ADDRESS: STREET /2.OS- / 0 ."t. Se. 16 <br /> ji CITY -7/ ZC -- / STATE I ZIP /d'2 D<19 <br /> lj �f2$�/� � - -/F%W i!ER PHONE: OWNER EMAIL: <br /> f. <br /> ILoNTRA.CTOR NAME: j e4-_/%69 ,Q e., =1/tt—,t(1 V/r J" 017477.0A/ GC_C <br /> °CONZ RAC s OR ADDRESS: STREET ( 2 f /50 a cgr. S( 14 4 <br /> CITY -�// 2 .�. STATE t/!/ ZIP may +,. <br /> II CONTRACTOR PHONE: �/2 f—5V 7 ^6 7/ CONTRACTOR EMAIL: 5 D t jMC$?G/L/rl'/L, CO diJ <br /> t;CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> liPRIip ARY CONTACT: a OWNER ®.CONTRACTOR ,,OTHER(Please Specify) ,t.r 41 of LlO OI' <br /> ii3ONTA.CT NAME: CONTACT PHONE: W t7 -- 95, ' -2�-/ 2 <br /> It/W-i ,G '' CONTACT EMAIL: 4.0. 'A C et- 0 , 0/-/y,, , G.0 /`f <br /> - - ____ <br /> N BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: 12 Z -22S-pAV---7 c&NT-S Heat Source: 12Gas DElectric ❑Other <br /> 113uilding Type: OSFR-Detached ❑SFR-Attached ODuplex 1 Multi-Family-#of Units: 1 S ❑Commercial ❑Industrial <br /> Type of Project: KNew ❑Addition CI Remodel 0Repair ❑T.I. DSign ❑Sprinkler ODemolition ❑Change of Use <br /> iDESCRIPTION OF WORK: - - <br /> II Got i7 721,e-r_,,,A/ o 5�,' <br /> JP 3• w iJ mac, /sr-c7,6 Zed- <br /> li <br /> lIASSOCIA T ED BUILDING PERMIT#(if applicable): 10� <br /> vECNA EICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn _Alteration _Repair Type of Project: pi-New _Addn _Alteration _Repair <br /> ti #of #of #of #of <br /> Fixtures List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures <br /> I� ,- A/C-Air Handling Units Heat Pump 3 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems . 4 Unit Heater 2„ Bathtub Urinal <br /> LGas Piping Boiler 3 Lavatory(Wash Basin) Drinking Fountain <br /> ^ ( Water Heater Refrigeration _ Shower Floor Drain <br /> d Gas Fireplace - Wood Stove - Kitchen Sink&Disposal Grease Trap <br /> r ..... _Gas Range Ducting _ Dishwasher Roof Drains <br /> R: Clothes Dryer Hookups Other: 1 Clothes Washer Medical Gas <br /> II I )Range Hood _ Water Heater Other: <br /> i 5 jExhaust Fan -- Sink(Service/Bar/Mop/etc.) Other: <br /> II rSPRINEA /SUPPRESSION SYSTEM <br /> g j Nurnber of Heads 1 <br /> ACKNOWLEDGEMENT:l 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 /> //Uti-ZU <br /> /(7 -/ PERMIT# <br /> Owner/Authorized Agent Signature Da (Revised 9/23/2016) <br /> i-L.( <br />