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14en- PERMIT APPLICATION <br /> ' BUILDINt MECHANICAL / PLUMBING / SIGI' ' -PRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERV <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:/?Ab Lt) Pine\tato Or:ue PROPERTY TAX#: s-i <br /> t� zoI <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1•¢- Everel- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET I?S Cra sma4a Way i -5 -2C0 ® <br /> CITY i a/ere t- STATE t/t ZIP F$2.®q A <br /> OWNER PHONE: f2S 2 1(-3(6tt OWNER EMAIL: <br /> CONTRACTOR NAME: Tan <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: 6rvaidorif,`}fl,i{ Pr CONTACT PHONE: t(-ZS-.3as-t:56,13 <br /> CONTACT EMAIL: btd ®r *at` 'rear -6 ,-ra <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: C LJ-re.rdy vacatf- Contract Price of Work: $ 31-5, <br /> Proposed Use of Building:atariru?/Ctth/zottle.i pub6'L ve i. Heat Source: ❑Gas ❑Electric Daher <br /> Building Type: OBER-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ,,Commercial ❑Industrial <br /> Type of Project: CI New ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition OChange of Use,k(S/A3tK <br /> DESCRIPTION OF WORK: °7 ke. gory-eif Evecer?WL() he_ ,viout✓i'M e / *_ ye hetat fpr-t4uu • trd ir5 n.Q.W harrt-Q <br /> ( &ccaf F-rk. 7164 praje -t io vrte. wee Ports la.ryler fit° iati Race Ceitirni re e(o�wn¢n� p^e1ec#. <br /> elf i.+Fa &LW Se to y e 1 yerhagalse -C• will be_ ajed eC�'• da-Li- u9 de <br /> lts accalundriw ccae-D t )11/frt,F� kr-e-c .rel future- t�l� b <br /> ASSOCIATED BUILDING PERMIT#(if applicable):a•'za p6�� -on a � a Y y <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 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 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# (on�� ��n Ll <br /> 3®,.. 6o(e-twP- �% . zitRIt l / 1} <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />