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PERMIT APPLICATION <br /> '1111 —:4 <br /> BUILDIN flECHANICAL/ PLUMBING /SIGN , RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIC=S <br /> *10110 <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> CPROJECT SJTEADD SS:C�� 5 J tv U PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> I . CONTACT INFORMATION <br /> OWNER NAME: (A) q y AIf hi/0V.S/"N • TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1/22 EA.s % CASINO IT //� ))a <br /> EUT f'L /7 CITY STATES/W''r ZIP ?8.20: <br /> bWNER PHONE: 4/2„.5"-- 7 7- A9b 7 OWNER EMAIL: Go/I V/y`/r,/ 1-4025 79 a Gr Ng/ L- <br /> CONTRACTOR NAME: ('UJ ii)'C 17. p <br /> CONTRACTOR ADDRESS: STREET /y 2 2. L 4 5 / L A S Ji}O ,/ .e214-I� 7 <br /> t7' t5k g I / CITY STATE A • ZIP 76 C <br /> CONTRACTOR PHONE: ,gd $ 7 337_ 67 MAIL: WA yiu l=HA/U5'EN 7?C06,014-lL,CDpIrt. <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: L�IOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: / CONTACT PHONE: Ill 5— 73 7 7 ;7 5 <br /> W A y /) EH 4 W 5 t/J CONTACT EMAIL:tuf4`//LIE HA t1/Sc,/ low 6j-olio, . .ciYG1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: S/y1J6-L t 64{y//6.y -Y 4-9-44, Contract Price of Work:$ 3 00-VO <br /> Proposed Use of Building: 5,,V -LC /�¢wt IL.y —1'R t)L( Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair DTI. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: j <br /> ' To 2/✓ 04 s rn C ' l 7-0 �r 2 /.5 E 1)20 cm 1q o [� (�1 -`�j5`ll t7 l✓ - <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 List of Fixtures #of List of Fixtures #°f List of Fixtures #°f 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 _ 1 Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting r Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> ' Range Hood i Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I 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 /> ‘'64CP 77?%74-(A--(-"t-- V-25--- / CO 100'1 ' 00i-I <br /> Owner/Authorize gent Signature Date (Revised 10/12/2015) <br /> Vi <br /> 7--- <br />