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041-17PERMIT APPLICATION— <br /> BUILDING /MECHANICAL/ PLUMBING I SIGN I §PRINKLER / DEMOLITION <br /> 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 /> 4 x.".`.. W ::4.!T:M `f a PittO.J,ECT.SITE;INFORMATION_.::...::::!. ... .. . <br /> fh <br /> PROJECT ZSjTI....AI�R <br /> DESS: .L S PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> 11 . " .. . 1 i "1 t r V :CONTACT INF.ORMATION'4 i.-A '.: : . . <br /> � it 1 1 <br /> OWNER NAME: 1".‘1\<!,._ ��\ tock` c(' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET qs-D-7 7-di f.-.J2 sr.:- <br /> //// CRY Eta �t.1L 44 STATE /ti A ZIP YO �r <br /> OWNER PHONE: (2^ 1/Z 2— 7 f/o27 OWNER EMAIL: <br /> . C� <br /> CONTRACTOR NAME: • r-e Q,At/�."}a,- � .) > <br /> CONTRACTOR ADDRESS: sTREer / 36-E fief,1 (A.)t r�l I L 4 �� 1� �j <br /> CRY NJ01A ✓'J? OA STATE l/I�►� 1 / LP g / r <br /> CONTRACTOR PHONE: j(�V 7 22 .37 to <br /> CONTRACTOR EMAIL: 74,., e S!)/Y;/L. Ed+X\ 2 <br /> CONTRACTOR LICENSE#(REQUIRED):/—IrejoAA S /3°210 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):0 S /3 rI?j <br /> PRIMARY CONTACT: DOWNER ❑CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: / CONTACT PHONE: 3 bO y/?Z 6-6 i U <br /> / Ids Al,Z I5 e ' CONTACT EMAIL: Ap,, 6-4 c,,, sd/A-A, l e-,--- <br /> BUILDING PERMITAPPLICATION : <br /> Existing Use of Building: Contract Price of Work:$_ 3 9Z 0 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: R-Detached ❑SFR-Attached ❑Duplex ❑Multi-Familyof Units: DCommercial ❑Industrial <br /> Type of Project: L New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: C ' £ +� f 'Y �c5.4„,..s G ,,,,Q 1 )+r- b <br /> R.4 .F 1..51.;1s d- )7e ck. t7 sy s 1,...--_s <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION .. . - PLUMBING'.PERMIT•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 Toilet Backflow Preventer(Inside Bldg) <br /> 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&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:ISUPPRESSION SYSTEM; <br /> Number 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.lam 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 /> Ot Ji 1// PERMIT# n ) (003103- <br /> (0O 00( <br /> 014r/Authorized Agent Signature Date (Revised 10/12/2015) 1 <br />