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PERMIT APPLICATION <br /> BUILDING ECHANICAL / PLUMBING / SIGNRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT <br /> SITE DAVE f EVERETT, vVA Q8a0/-%oa3 PROPERTY TAX#: <br /> 3014 i4°/T OU'39/7/ 9O.23CO <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:50TI,£R,LAP1b "NI VESTMENIT5 L LC.... TENANT NAME(If Commercial): 5 C ACOM, <br /> OWNER MAILING ADDRESS: STREET 02 q/5 C4ESTANT- <br /> CITY EV CRE TT" STATE v A ZIP 9 Bao I <br /> OWNER PHONE: a5-3 (-7_ 8 a54 /1 OWNER EMAIL: j50vthulickc ea,115e,Q L'Om.COm <br /> CONTRACTOR NAME: IA►I Ck.2 C <br /> 1 Lao& -Ofv.strOC±//��1 0/1./ Inc. <br /> CONTRACTOR ADDRESS: STREET „5-d,(o NI• WEST A\/E I.14, <br /> CITY ItRL-(/� G I O STATE VIA ZIP 98c23 <br /> CONTRACTOR PHONE: 360- '135- O(0 10 CONTRACTOR EMAIL: rntc{1Qe. I COn,nt(c c n-tc1., I. COM <br /> CONTRACTOR LICENSE#(REQUIRED): M I C I4 A L- C- OS I MC CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): q 70 q I <br /> PRIMARY CONTACT: ❑ OWNER 14 CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 0/0 4,_7 c7(7_ 4'576, <br /> 1\4 IC144E:L LLON! CONTACT EMAIL: fr c,haelleGn frit Gi9MQ � Com <br /> BUILDING PERMIT APPLICATION <br /> oc <br /> Existing Use of Building: V tLAL)1 Contract Price of Work: $ . Off9DO. <br /> Proposed Use of Building: OFF(CE5 Heat Source: OGas ❑Electric ❑Other <br /> Building Type: DSFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: IZICommercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair $T.I. ❑Sign DSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> XaTER/0 OP6NA bES <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 #of #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> AIC—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 /> SPRINKLER/ 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.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 State Contractors Law 1 27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMITTi (a) 001il/.4"/: <br /> 0- ---- <br /> Owner/Authorized A n Signature Date (Revised 10/12/2015) <br />