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grr PERMIT APPLICATIOI I <br /> BUILDING ECHANICAL I PLUMBING I SIGNRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PeOZST LOMat ? AVE PROPERTY TAX#: V 01r2" in is 00900 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: CITY OP ,a.N1g5-7-`r TENANT NAME(If Commercial): EUaf-VT 0Ealeg <br /> OWNER MAILING ADDRESS: STREET ..ZXD2.. WyM OgFi 1'UE-. <br /> CITY f;Vp IT STATE Wlk ZIP "/OZD/ <br /> OWNER PHONE: 12.5�2S- F3596. OWNER EMAIL: VSQYICt[Z€tsVGrcYfG�a • 0✓ <br /> CONTRACTOR NAME: r(T 64 _ u <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): r(� G c6rio, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): D0'f�3Cj� <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR LWTHER(Please Specify) Age,gIT ecr <br /> CONTACT NAME: gOT CH/J/j�j1 J /l4LL AgCN• CONTACT PHONE: 4 - Zs•� _ Q5&S <br /> ATTIi: MI 14S WALKE. CONTACT EMAIL: milks P41,I.1/1 cosh, GOI•vl <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: A-3/B, 5-2, Contract Price of Work: $ 60/A^/rI <br /> Proposed Use of Building: NO G Hof/&E. Heat Source: ❑Gas DElectric DOther _ _ <br /> Building Type: ❑SFR-Detached USER-Attached ❑Duplex DMulti-Family-#of Units: ®'Commercial Dlndustrial <br /> Type of Project: ❑New DAddition ❑Remodel DRepair fl. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Emop£t_ o RergooMt <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 <br /> List of Fixtures #of List of Fixtures #of List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-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 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT#" <br /> V// <br /> Z0/6 1005 <br /> wnerlAuthorized Agent Signature Date (Revised 10/12/2015) <br /> g <br />