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44-17 PERMIT APPLICATION <br /> BUILDINI ECHANICAL/ PLUMBING /SIGN RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIC68 <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:acpJ vk1,r exe PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision V� C Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: oe- ct4Ct A TENANT NAME(If Commercial): 6e f*a \Akx\45 <br /> OWNER MAILING ADDRESS: STREET 2,Q75j \}Jf- -( -ore Al/_e <br /> CITY STATE l ZIP —1 50.0\, <br /> OWNER PHONE: LQ-5 95S—C0-4-1-R- OWNER EMAIL: Ir( pa- (t ter.(cry) <br /> CONTRACTOR NAME: .14y‘5 1oQ-c cod C -o V llam <br /> ,1✓ , <br /> CONTRACTOR ADDRESS: STREET y^( CO c :7 1 Pcki.Q AE <br /> CITY Ti i(-1'l A7"^,r) STATE ULPF ZIP a(63 <br /> CONTRACTOR PHONE: 3Q,),0— ef53- 700.3 3 CONTRACTOR EMAIL: ,^( 0; ���5X-Cer nA ( �, <br /> CONTRACTOR LICENSE#(REQUIRED): AYL- P� p � CITY OF EVERETT LICENSE#(REQUIRED): 5 I4 ly <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ` fHER(Please Specify) I..11a -. <br /> CONTACT NAME: CONTACT PHONE: • <br /> J\(i �ME7 CONTACT EMAIL:fr@( ISYobia,r\ L A1..(CAm <br /> "� BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 6VdT Contract Price of Work: $ Ial C60 <br /> Proposed Use of Building: N t( Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: 'Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel Repair ❑TT.',�.I. ❑,Sign ❑Sprinkler �(❑Demoli _lition CI Change of Use J n�,_, <br /> DESCRIPTION i4 WORK:1 nc ��Qjrc ` OCJt-(m rY 1 `\ a �SZe al c � A Y'elA3 VO SL{c5 e 1 . <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 #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-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:kl-e-V_CO . 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 mad , <br /> e, <br /> and I comply with the State Con . ... .. PER w 18.27 RCW and 296.200A WAC. Z <br /> \ 1 I City of Everett Official Use Only <br /> j, rprpiv <br /> / 11 ` goP 511- Cl. <br /> Owner/A b orized Agent Sf Date (Revised 10/12/2015) ,., a„f .15 <br />