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PERMIT APPLICATIO 4
<br /> BUILDINC ECHANICAL / PLUMBING / SIGN11
<br /> It '
<br /> ./OPP',,,••
<br /> RINKLER / DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICL-
<br /> velay
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: IO`il 5 „ ,--ev, lAkat PROPERTY TAX#: Z$0421y 00202400
<br /> eve-vve._:H- , w A
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: low,. Lc4.vt_e _ TENANT NAME(If Commercial): SKa.j j.v.ve_;4-yy,.�,J.3, LLC.
<br /> OWNER MAILING ADDRESS: STREET 31 6 }-/H- aJ- Rd. �"
<br /> CITY Eve„,-e11.. STATEv� ZIP 9g 2.03OWNER PHONE: OWNER EMAIL: f j a.vl,,c_g. s AJ a-j elt_ieA.vi.t=. Go vest
<br /> CONTRACTOR NAME T t.".,1 F Fvt e( (t,NS-re 1 for -I
<br /> CONTRACTOR ADDRESS: STREET 0,1(.,s ee,,,,It`7l JAL(
<br /> CITY ',vE/k�/:::7.-1- STATE (AXIS ZIP 962_6
<br /> CONTRACTOR PHONE: i--:(2:=.;. 3,(‘-1-6. SC(1:) CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CC. ( 4 yf;'..-tcT i i.-/(L3 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O t 2- /is 0
<br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR a OTHER(Please Specify) Desi91.4y-
<br /> CONTACT NAME: MGwIRi. Shaw is� CONTACT PHONE: (K25) 2.S2_ 216 3
<br /> CONTACT EMAIL: ✓V1Glvla.,10 Z3l2.c•vv-CIn,i-Ire-C, �. Ceyy�
<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: 6 , 5-1, U Contract Price of Work: $ 15� 000
<br /> Proposed Use of Building: g, s— 1, U Heat Source: Z4 Gas ❑Electric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ,Commercial ❑Industrial
<br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair 21T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: Lf, /wprz s ;nc d 6- n®f '-
<br /> I o we, (c.v.-44 - r- / c-vt-e.�l; n o, .0 A,,� .-CA-c,,...5 cwt 6, (AN SYac v1e s01-✓ ,
<br /> 07711,
<br /> OVN -Ly_ SL Co cd.Uo,/ S GSM{_ lye
<br /> NO C�Atti G ,,,,,..„...L., Iro OGGaa4,,Anc"..3 tg�G,5i.}� vJ0•P-K. eA-c .
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): 7
<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 #of List of Fixtures #of 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 0
<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#TPERMIT#- 04
<br /> ,,,,,,,,.....,.../c "�. f2 • �/6 otct
<br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015)
<br /> NIS
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