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0 PERMIT APPLICATIOAS <br /> BUILDING / MECHANICAL /PLUMBING I SIGN /SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-6810 1 FAX 425-257-8857 1(E)everattePSANeverattwa,gov I www.everettwa,govipermits <br /> LVtlue or Block Ink Oftly,Piease) PR CT SITE INFORMATION <br /> tsll�i�'Iv?e­!:&L La�fte-- ATY TAX M <br /> PROJECT SITE ADDRESS: <br /> LEGAL for now construoon, short platisLi6division LotNo­ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: -� cekot,� TENANT NAME(it Commercial), <br /> OWNER MAILING ADDRESS., STREET <br /> CiTySTATE A <br /> OWNER PHONE; ]OWNER EMAIL <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CfTY Ol EtIERETT SUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 11-m2 I OWNER C1 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME; CONTACT PHONE: <br /> u,-11-:,-5 CONTACT EMAIL: r <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Corttrsct Price of Work: <br /> Proposed Use of Building, lHeat Source: �Obes JZ1EI'e'CtriC 130ther <br /> Building Type: OSFR-Detached 13SFR-Attached 013uplex OMuffi-Farnily-*of Units: 13Cornmercial 01ndustriat <br /> TypeofProject: ONew OAddition Remodel ORepair 13T.1. OSign 13Sprinkler ODemofition OChangeofUse <br /> DESCRIPTION Of WORK: <br /> ­ <br /> 44- <br /> 1ASSOCIATED BUILDING PERMIT#(it applicable),, <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn Alteration Rcoalt Type of Project: <br /> _New —Addn —Alteration ____Repair <br /> of List of Fixtures of List of Fixtum Us(of Fixtures *of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> AIC-Air Handlin2 Units Heat Pur V Toilel, Backilow Preventer(inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Drinkl2s±ountain <br /> Water Hester Refrigeration tShower Floor Drain <br /> Gas Fireplace Wood Stave lKitchen Sink,&Dimosal Grease Trap <br /> Gas Range Ducting 10ishwasher Roof Drains <br /> Clothes Dryer HuokuEs Other" Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink(Service,'Sar/Mopietc.) Othef <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> [Number of Heads <br /> ACKNOWLEDGEMENT,t have reviewed this apphdation and confirm the information contained herein is true and correct. Work done pursuant to this permd must comply with <br /> current federal,state,and local law. The granting of a Pem*only authorizes approved work and no deviations therefrom.Deviations must first be authorded)n writing tram the <br /> Suilding Official before being authorized under any cmumstance,I the owner,or I am autharavd by the owner of this property to perform the wort.,for which application is made, <br /> w �d I comply with the State Contractors Law 18, C WAC <br /> City of Everett Official Use Only <br /> PERMIT.# <br /> OwnerfAuth",odAgent Signature Date (Revised&20,2016) <br />