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- + PERMIT APPLICATION <br /> F_.. ,) BUILDING/MECHANICAL I PLUMBING /SIGN I SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> tt ' f>s tl' 3200 CEDAR STREET,EVERETT,WA 98201 <br /> 2kki-7 "' t [�� )425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> $1 <br /> � Rroe e Black a& )rrak Only Please) PROJECT I'p T E Il it(i G�lill iTiRO1�9 <br /> 4 <br /> ,ROJECT SITE ADDRESS:2)3 Z' E ' 4V e (.(9 PROPERTY TAX#:gp°O*l g•op�o 700 <br /> iLEGAL for new construction: Short Plat/subdivision Lot No. n (attach copy of long legal description) a1 / <br /> 1�,-.,=s CONTACT IG FCRIVIATION <br /> I " /�/4 L/ 7� ,1'- -,f- TENANT NAME(If Commercial): <br /> ,Dffd`s'�ER NAME: � � ) <br /> !II'OWNER MAILING ADDRESS: STREET /2.0 s- /30 n %%. Se. 40 A. <br /> CITY J72..( /` STATE L(/ ZIP / ' Dd <br /> `,�stfUtE '- ��^ �olf� EMAIL:OWNER EMAIL: <br /> R PHONE: 2�/" . � <br /> 1 ONTRACTOR NAME: 59 5,7-G AA/— /'6 / -- ?fro T1 -70,t/ GG C <br /> IICONTR .0 T OR ADDRESS: STREET «j,' /50 a �ir -Q ' _ <br /> _..._- <br /> 4-7 <br /> 1 9 CITY 972'67-7r- STATE Wit-- ZIP? p r p I ON T RACTOR PHONE: .�2,r-5V/ -6 C�/ CONTRACTOR EMAIL: 5 D d 4 ff--e/tiCS OGI-m-a, co 1 <br /> IlCOONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> 1•.PRII?1ARY CONTACT: a OWNER ®.CONTRACTOR ,.OTHER(Please Specify) d ry sf7 LUIO QI <br /> CONTACT NAME: CONTACT PHONE: gd 6 - 6753— _2- -/ 2 <br /> ffY�t /G-( CONTACT EMAIL: C• A C f ps/ , CAD n <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building; Contract Price of Work:$ <br /> ..___ <br /> (Proposed Use of Building: 122- -7 mW`GT5 Heat Source: I2Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex I Multi-Family-#of Units: {5 ❑Commercial ❑Industrial <br /> hype of Project: gNew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> IDE'SCRIPTION OF WORK:il <br /> �at '7 -L'}ti/ - - <br /> jli <br /> t IA)Ai (Ant) tom/,&-r7,& 4- A - ' <br /> aASSOCIATED BUILDING PERMIT#(if applicable): 0- <br /> 1 <br /> FIECNANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> 3TypS of Project:A New Addn Alteration Repair Type of Project: V.New Addn _Alteration _Repair <br /> #of I #of #of #of <br /> 11 i'.t=ix�u.es List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> r- - <br /> - A/C-Air Handling Units Heat Pump3 Toilet Backflow Preventer(Inside Bldg) <br /> tii Forced Air Systems -- Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 3 Lavatory(Wash Basin) Drinking Fountain <br /> I�Water Heater —Refrigeration _ Shower Floor Drain <br /> d -+ Gas Fireplace - Wood Stove _ It Kitchen Sink&Disposal Grease Trap <br /> l' — Gas Range Ducting _ 1 Dishwasher Roof Drains <br /> R- I Clothes Dryer Hookups Other: 1 Clothes Washer Medical Gas <br /> L I Range Hood - _Water Heater Other: <br /> f. 1Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> jj SPRINKLER/SUPPRESSION SYSTEM <br /> ( <br /> � Number of Heads <br /> m <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.lam the owner,or lam 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 /> e/l7D( /?!6 <br /> Owner/Authorized Agent Signature 7ff// -.-Date (Revised 9/23/2016) �. <br />