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• • <br /> PERMIT APPLICATION <br /> "IIP'140/4 (A.1 <br /> BUILDING/MECHANICAL/ PLUMBING I SIGN /SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 . --It`I4 <br /> (P)425-257-8810 ( FAX 425-257-8857 I(E)everetteps©everettwa.gov I wwweverettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SIT DDRES PROPERTY TAX#: <br /> ,hail C Ste[ 1IGCell' WIN '°.VLOt <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of tong legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Mat-- ...Itii e °t ro r-1 Gott well TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET t tOt ced.r %,..f _ <br /> circ Everett STATE WIN 2ir? qt:c2©t <br /> OWNER PHONE: Las 'RIR toss t OWNER EMAIL: Af j do Ito:M.1 e.„ ,tYltx l • Co jun <br /> CONTRACTOR NAME: Spire c ra. <br /> CONTRACTOR ADDRESS: STREET 2.4U 151. Pose. S• sir '2.4t!� <br /> c�3'ro��SeLt i"C STATE Pt zsc ct2 V3 ti <br /> CONTRACTOR PHONE: tr`v,,j CMOS CONTRACTOR EMAIL: SO %O.CAMIn @cztottf rA.• C-ow <br /> CONTRACTOR LICENSE#(REQUIRED): %VMS zicis 14R CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): () b ")2., <br /> PRIMARY CONTACT: 0 OWNER R. CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: ii � 4 CONTACT PHONE: te)0 1!)1!)(05(� oo <br /> ,,�arvc t t`�I 1 CONTACT EMAIL: 50eitaraida1 In e. sot-tem... C e nn <br /> BUILDING PERMIT APPLICATION <br /> . <br /> Existing Use of Building: H°I-At Contract Price of Work:$, i ;ec'oo <br /> !/ <br /> Proposed Use of B�/uilding: `' Heat Source: DGas ©Electric ❑Other <br /> Building Type: t1dSFR-Detached OSFR-Attached DDuplex DMulti-Family-#of Units: ©Commercial Dindustrial <br /> ,,..,,r� <br /> te <br /> Type of Project: 'E New DAddition DRemodel ❑Repair DT.I. DSign DSprinkler ©Demolition DChange of Use <br /> DESCRIPTION OF WORK: <br /> lnsrtt l I a. 5. to k\,/Q PV S i' sn arN r 00-c . <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 <br /> List of Fixtures #°f Lfst of Fixtures #of List of Fixtures #°f 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 Water Heater - Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> • <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> 'Number of Heads ' <br /> W . <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 /> 1 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 lam authorized by the°inner of this property to perform the work for which application is made, <br /> and t comply with the State Contractors Law 18,27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 4 ,„ A.../:\C 2-tb-' 1b I <br /> PERMIT# t i Il (001/ A(fJl�^ <br /> • erlAuthorized Agent Signature Date (Revised 10/1212015) <br />