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P PLICATION <br /> BUILDING / MECHANICA / P_LU_MB / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF E IT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> OL (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 /> PROJECT SITE ADDRESS: f 20 f�/, GAS/.t16 &P• UN/T //r{ PROPERTY TAX#: QQ4j7?36 CSO/00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: FAOF ,4Ax ID i—,Lc TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 12!00 QLVd 5Ar 250 toJ <br /> CITY l'S 4S' STATE �TLI r it/;(Jr- ZIP 57 <br /> ( OWNERPHONE: yZ5=- 3 S3-, .5_ OWNER EMAIL: <br /> CONTRACTOR NAME: 86 kE T' .4e85l.69..+ 7 OA) <br /> CONTRACTOR ADDRESS: STREET .? SOJ4re /3/ Sf P Svp 6e LOO ,} Q <br /> CITY Q q.t STATE IATA ZIP ` P/49- <br /> CONTRACTOR <br /> /49- <br /> CONTRACTOR PHONE: — CONTRACTOR EMAIL: ­)LF6- (.e VS.at1 I'. eon <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER I�CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: g25- yo-979y- <br /> K,l I e-CV- o1CCS CONTACT EMAIL: e✓G 1,97CP A o¢W&,L. Co-i <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: vl+t lCe-r+.l Contract Price of Work:$ ',7e) . <br /> Proposed Use of Building: J r-44-! Heat Source: ❑Gas L9Electric ❑Other_ <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex EYMulti-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> t�EPA.►R- rt aC DamA&E 1ac1UA1 w,A&9OWS 'K i- Cn'j t ' PIS <br /> or� , CAb'rN—t-S + -' (Cov- 6 G 7 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION UM_BING- ERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump j Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater j 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&Disposal Grease Trap <br /> Gas Range Ducting ( Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other. Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> / Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:1 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/am authorized by the owner of this property to perform the work for which application is made, <br /> and I complywith the State Con actors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 0 , - %� ) <br /> Owner/Aut g t Signature Date (Revised 5/20/2016) ALJ <br />