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Jan 0516 02:58p p.2 <br /> 4en- 411 PERMIT APPLICATION <br /> BUILDING /MECHANICAL 1 PLUMBING /SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES 1 -6-id <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> in / 9 1--015 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> f PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:01 too g _i,Vil i CL - i Aix i- `PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> �{{ CONTACT INFORMATION <br /> OWNER NAME: l"zj Yt6 1 fl- 4 I kr1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: smear ,.(Q 0 2- (iv.,v-eA al--'8- ) i it-e - <br /> cnY E V-€-'Y 1 STATE tea ziP cwgen <br /> OWNER PHONE:4-,,)-6 • 1 Goo) -- Lica 5 a-- OWNER EMAIL: <br /> CONTRACTOR NAME: ( 616 144. +J-ea +-j -- /44- r 7----1-----.41-1C--- I. <br /> CONTRACTOR ADDRESS: sraer=r C--I 7 - ' P--{/1Ptitt l't <br /> carr 0\t 0..,Y 6 Y t i ke srATE ce_) ‘ _ z, $a'�� <br /> CONTRACTOR PHONE: -3- 5- LG06-) .CONTRACTOR EMAIL: (/ot''G .4-rO/'4 1/1.A.6 ltr' ( YY1COS+.)IQ-}— <br /> f <br /> CONTRACTOR LICENSE#(REQUIRED): Irk bIC(1 , ,, 1Ct `�1 l 5- (CITY OF EVERETT BUSINESS LICENSE I/(REQUIRED):C)4-/-4.')i4 , <br /> PRIMARY CONTACT: ❑OWNER ,CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACTO � NAME: CONTACT PHONE: L 1 JS. 5-5s. 2 <br /> i r� CONTACT EMAIL:r/10 jr 046 )mh oz d C 0 q,ca 64-.ner- <br /> BUILDING PERMIT APPLICATION , <br /> Existing Use of Building: Contract Price of Work:$ 06/1-1(.1 G�-2 =;111q id% <br /> Proposed Use of Building: Heat Source: peas ©Electric ❑Other <br /> Building Type: FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Familyof Units: ClCommercial ❑Industrial <br /> Type of Project: New ❑Addition CI Remodel rt'epair DT.I. ❑Sign ❑Sprinkler ❑Demolition CIChange of Use <br /> DESCRIPTION OF WORK: <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 /> Fixtures List of Fixtures F List of Fixtures Fixtures List of Fixtures Firctur of <br /> List of Fixtures <br /> A1C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> I 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 I SUPPRESSION SYSTEM <br /> INumber 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 end no deviations therefrom.Deviations must first be authorized/n 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&ate Contractors Law 18.27 RCW and 296.200A WAC. r ^,�j <br /> �� — City of Everett Official Use Only,-T 1(,/-^, <br /> PERMIT <br /> (1 /-� / lp h1t9OHOI <br /> OwnexiAuthorized Agent Signature Date (Revised 10/12/2015) <br />