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: El <br />--- <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 I www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />1-t PROJECT SITE ADDRESS: 105- <br />/02 142 '3 © <br />PROPERTY TAX #: Z S6N2gC>0 20 //o5 <br />It <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />n <br />OWNER NAME: 'SJ'. oh c rX Sty r o LLG TENANT NAME Commercial): <br />J(If <br />) <br />OWNER MAILING ADDRESS: STREET (; S`.S� /'j')Ov►¢ �ye.r !;- S4-e l %00 <br />) <br />CITY Frei 8 6, ) 5(0 STATE �j ZIP <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: {a I H S S k, 10 <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): PC! LZ5 t 8 7 <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER R CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />us 1/I �uiL� <br />CONTACT PHONE: 96 I 234 o e? 3 <br />CONTACT EMAIL: JC Gluf t.�► a 1JN $�eu75 9VrG,GU1* <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: u ) aP6- � S <br />Contract Price of Work: $ <br />Proposed Use of Building: <br />Heat Source: ❑Gas ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ulti-Family-# of Units: Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition ❑Remodel MRepair ❑T.I. ❑Sign []Sprinkler ❑Demolition []Change of Use <br />DESCRIPTION OF WORK: �(aGr ,� wi'+ ✓!eW . .[n+'w�i„(� Nnr w�clu ng el�bus �' 'Fkn 5 /✓1 6 �1Zf�rJrs71� <br />(kwrvf/�' j nvvt +-�nf�,•,y t-doie '#Ns 3 kr fc4wsl ceplc'4 �j wryle ✓ <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New Addn Alteration Repair <br />Type of Project: _New _Addn _Alteration _Repair <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />A/C —Air Handling Units <br />Heat Pump <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />Kitchen Sink & Disposal <br />Grease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />Other: <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />Water Heater <br />Other: <br />(9 <br />Exhaust Fan <br />Sink (Service/Bar/Mop/etc.) <br />Other: <br />SPRINKLER <br />/ SUPPRESSION <br />SYSTEM <br />Chemical or water <br />I I <br />No. of Heads <br />ACKNOWLEDGEMENT., 1 have reviewed this application and confirm the information contained he 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # <br />0/ fR I At(%I( — Its <br />Agent Signature D to (Revised 912312016) <br />