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• S <br /> PERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> j J 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 ((E)everetteps©everettwa,gav 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION �^ <br /> PROJECT SITE ADDRESS: I5 IC; t- 1--�letc.T l f i [PROPERTY TAX#: 1 ft,ni) --/VO T S' °.1/ ,011r ir1 <br /> LEGAL for new construction: Short Plat/subdivision; Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> t, <br /> OWNER NAME: (51 i tic- er, (f,)i TENANT NAME(If Commercial): (;)1'i te.. l tsti-f t'r+ <br /> OWNER MAILING ADDRESS: sTREST 13 to ..E.1. vetre7' "Liall WALL' <br /> CITY tom-^.... <br /> " 47.- STATE L„Jf l- ZIP c6-,),,,,-%",, <br /> OWNER PHONE: `'t,2.fa' 3 q 7 g '<'? OWNER EMAIL: <br /> CONTRACTOR NAME: V rill-( tltt 444 f fjor'.U,t e. <br /> CONTRACTOR ADDRESS: STREET ,nl {s�-t®) t ,, t,�} r s } <br /> G. <br /> Cir, .e,N1C STATE (J.)PC ZIP �"1 U / <br /> CONTRACTOR PHONE: X06,_ 3`' (-6/-i CONTRACTOR EMAIL: .;' j t(,`i r4-( <br /> iie0,1 4,1,1,4A <br /> CONTRACTOR LICENSE#(REQUIRED): 6d)- (-4 IC)`' Cbiill CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ,.(...OP‘ <br /> PRIMARY CONTACT: In OWNER 1 CONTRACTOR ID OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: r L,f c. <br /> �~ CONTACT EMAiL: " o+f j <br /> I...-�°E�rY'� ��� _ leck-iY`1v. u,`tr2rGil4 ,,73,1 rC.:C3i'" <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: <br /> Proposed Use of Building: Heat Source: CIGas ❑Electric DOther <br /> Building Type: ❑SFR-Detached CDSFR-Attached CIDuplex ❑Multi-Family#of Units: ©Commercial 0Industrial <br /> Type of Project: ElNew I:Addition DRemodei ❑Repair DT.I. CjSign OSprinkler °Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> Y kQ, afiltl. W -6 v <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 /> NC—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 ii Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPPRESSION 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.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 RC W end 298.200A WAC. <br /> City of Everett Official Use Only <br /> �f,2�.,., iµ Y 5:—/4-16 <br /> y/4µ16 PERMIrp1 [001- - <br /> # t J � <br /> ( er/Autho�rizzed Agent Signature Date (Revised 0/1212015) <br />