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4 tr j • PERd IHT AP�::;1,_.�CATRD <br /> ;; ,' [3 ii1E..DONG / iiiiECHIANiCAL. / PLUMBING) / SIGN / SPRINKLER/ [DEMOLJ f DoN <br /> T _ _ CITY OF EVERETT PERMIT SERVICES <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 /> (Blare or—Black Ink Only Please) PROJECT SITE INFIRMATION <br /> PROJECT SITE ADDRESS: !b ! I g A. /9 lit7 4447. cf. j PROPERTY TAX#: ale 6J 20,3 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> IOWNER NAME: !4/V4' , -i'/AJ ¢ 7,14'i ueoc, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /b3O q 4 0- 7!h /7/Z re- , <br /> CITY 9 tt4.- it v e- STATES £j4,i A- ZIP ?g d V <br /> OWNER PHONE: .. OWNER EMAIL: t / <br /> �' rl`� 4 l v••mot t..,v w-,..) e Q n,.. Ki.j' G'Rrs <br /> 'CONTRACTOR NAME: 'l 6 „17, <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> 1 CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR /a eTHER(Please Specify) /_ ZC_—( t 7 -C__"T <br /> CONTACT NAME: CONTACT PHONE: <br /> toss` �.r"'�e.s.�t C..r./-L�� 2 S Z. - exo. 1 J 3 <br /> 1 Z /4a C-/-t I —TIC—C-7' r'—r CONTACT EMAIL: i^0 S'r t(1-c,- .1-.,.Ci-4,,'C. ,ce..1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: S I h-S re Ire_-C's Hof-e ii L t _ Contract Price of Work: $ <br /> k: <br /> Proposed Use of Building: T o 1.....A' H o <br /> ft" Heat Source: DGas DElectric ❑Other <br /> Building Type: DSFR-Detached ''•.FR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial Dindustrial <br /> Type of Project: ❑New DAddition ❑Remodel DRepair DT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ° P1• Oiv,f e•e7. I2 vA! 1? Tvw N et0 ‘,S.ac C41r1 a 1.4.? , <br /> w I 1 n t t,/ D 4-L.... r ER M t-7:, � 11- - v N c; <br /> ASSOCIATED BUILDING PERMIT#(if applicable): -! / GtK,t i< <br /> MECHANICAL PERMITAPPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn _Alteration ^Repair Type of Project: ^New Addn Alteration Repair <br /> #of #of List of Fixtures List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump 2 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems r Unit Heater I Bathtub Urinal <br /> Gas Piping Boiler '2.. Lavatory(Wash Basin) Drinking Fountain <br /> / Water Heater Refrigeration 1 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 1 Clothes Washer Medical Gas <br /> / Range Hood 1 Water Heater Other: <br /> 3 Exhaust Fan _ Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water ➢ No.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.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 /> PERMIT# <br /> .1(1\---ezie----------- <br /> C I g o 3-o<_5 <br /> Owner/Aut orized Agent Signatu'e Date (Revised 9/23/2016) <br /> I z/ <br />