1402 SE EVERETT MALL WAY RUE 21 2017-01-13

___ PERMIT APPLICATIO BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER-�QEMOLITION � CITY OF EVERETT PERMIT SERVICES C_ __ --- 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJECT SITE INFORMATION PRpJECT SITE ADDRESS: PROPERTY TAX #: !-/�' � ; ; [- "t- �' , f _ N G L ;, .-r LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: t i ��>� -� � � •—(�j� �� " �:; i� TENANT NAME (If Commercial): �� ' OWNER MAILING ADDRESS: sTREET ) �, ' ' �� _ �a `j ��: �L�i�j cirv �%-�_v'� I` STATE Ct� ziP �=%Z.Ct� 1Z OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: �- � - ' c ��,:��,��-�`� Ly�_, CONTRACTOR ADDRESS: sTReer � � � '� �;-b� �� ti>� k: �j � t - CITY �L,--s2�" STATE �Ir� ZIP C �� I CONTRACTOR PHONE: Z„� —(k�)C — O� C�� CONTRACTOR EMAIL: CONTRACTOR LICENSE #(REQUIRED): ��.,� �.� ��j(„r CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: BUILDING PERMIT APPLICATION Existing Use of Building: '�, �� ' �. L � 4_ Contract Price of Work: $ Proposed Use of Building: ^_L�=��-`� r�" � L_ Heat Source: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: Commercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler Demolition ❑Change of Use DESCRIPTION OF WORK: �^ t � �U ��,�E ��-� �� a� f.� pr�-� r r ti�c o�� u�-� �k- .��c.c . S� �� , ?��'� � �J� 0 ASSOCIATED BUILDING PERMIT # (if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair # of List of Fixtures # of List of Fixtures # of Lisi of Fixiures # of List of Fixtures Fixtures Fi�ctures Fi�ctures Fi�ctures A/C—Air Handling Units Heat Pump Toilet Backflow Preventer (Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory (Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink & Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink (Service/Bar/Mop/etc.) Other: SPRINKLER / SUPPRESSION SYSTEM Number of Heads ACKNOWLEDGEMENT: I have r' ed'this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with current federal, state, and lo aw. .Ife granting of a permit on/y authorizes approved work and no deviations there(rom. Deviations must (irst be authorized in writing from the Building Official before b g aut nzed 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, and I comply with t� ntractors Law 18.27 RCW and 296.200A WAC. Ciry of Everett Official Use Only � � PERMIT".� � �(��"�� ! � -� - �j/ /,y U Owner/Authorized Agent Signature Date `� (Revised 10/12/2015)