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0 PERMIT APPLICATIOI41) <br /> +UILDING I MECHANICAL I PLUM:ING I SIGN / SPRINKLER/ DEMOLITION <br /> ai CITY OF EVERETT PERMIT SERVICES <br /> viN <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> r(SIane or Black 8utk Only Please) PROJECT SITE INFO,•MATION <br /> PROJECT SITE ADDRESS: yvl 0 i ft i �VI$J, ,y-C.,1 l PROPERTY TAX#: �)( V V VJOV3o� <br /> LEGAL for new construction: Short Plat/subdivision 1 Lot No. (attach copy of long legal description) <br /> p 1) p C�•INTACT IIFOz.MATRON 1 In (`n } `/ R`l1 <br /> OWNER NAME: 1 pine T Y Dpe,�'h'fc (,IL Q4 TENANT NAME(If Commercial): �---e0osS\oI11 U'I n1I IUI ' 5C )V I <br /> OWNER MAILING ADDRESS: STREET 1 OG I�j F'Ve G(een YV(V\ 1 �" <br /> e\ CITY (EVeVek J STATE WA ZIP qt a <br /> 0,4 <br /> OWNER PHONE: (142 J)CjSI_' I 1-1 O OWNER EMAIL:? \,P\ DV!A•`!M ' AMF , ( "'OM <br /> CONTRACTOR NAME: TEX) <br /> CONTRACTOR ADDRESS: STREET <br /> CITY S FATE LIP <br /> i CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> • <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: N\Ci{ , Sn-I-" CONTACT PHONE: (31,O)3S L4. -5 8 WO <br /> CONTACT EMAIL: I V i 'D S O/I t* CI Vi Tyk-That` C&'c{) <br /> r r BUILDING PERMIT APPLICATI•N ; r>- ` <br /> Existing Use of Building: 07T 1(t: `- ASSC loly (B 4{�-3-) Contract Price of Work: $_ 50Ct I <br /> Proposed Use of Building: FdIACat1QYIO. «) Heat Source: ❑Gas ❑EI t ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: o cial ❑Industrial <br /> Type of Project: ❑New ❑Addition DRemodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ,Change of Use <br /> DESCRIPTION OF WORK: C11 mice 0.c occvt 3c ny, film() ofli ce tD ec Acati iwi \ -fGct til ( K-(Z).. t o wOYK <br /> PY�� I--ft�e (f fl {er, , r v / <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATIr•L <br /> Type of Project: _New _ Addn _Alterat' n _Repair Type of Project: New _Addn _Alt Lion _Repair �I <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures 1 <br /> Fixtures Fixt res Fixtures Fixtures <br /> —_ A/C—Air Handling Units Heat Pump _ Toilet 1 Backflow Preventer(Inside Bldg) <br /> 1 Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Dispos Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer ookups Other: Clothes Washer Medical Gas I <br /> Range Hood Water Heater Other: <br /> Exhaust F Sink(Servi /Bar/Mop/etc.) Other: j <br /> SPRI LER/SUPPRESSION SYSTEM <br /> Chemical or Water I INo.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.1 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 /> ;- o o r 7-t � <20 <br /> Owner/Au zed Agent Signature ate (Revised 9 9 9/23/2016) <br />