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OreEn" PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ 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 /> PROJECT SITE ADDRESS: )2tl02 04, r'1 v'e ,5L" PROPERTY TAX#: 2605 2CEo'C & 7(0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> rr e,,'' CONTACT INFORMATION r <br /> OWNER NAME: L- t 'hi i�nldr >, I ii - Ts-le _ TENANT NAME(If Commercial): (..'I W15( t 11foiv t`, ne;5 <br /> OWNER MAILING ADDRESS: STREET F.C_ 6e,x c-N7 <br /> 7 <br /> CITY cilUgta'iiii t. STATE tj;,� ziP 9bc 79 <br /> OWNER PHONE: / /OWNER EMAIL: <br /> /n <br /> CONTRACTOR NAME: C C. \ \€ +i(16 04)4Coo(jvu <br /> CONTRACTOR ADDRESS: STREET T C)_ I DK pc 9 <br /> CITY 14,i( �)11 fl(1 STATESTIt/ l ZIP /6O EJS <br /> CONTRACTOR PHONE: `'1 Z> - C,'21- 12'1.3 CONTRACTOR EMAIL: 'J E're'nY6' C FA'1— (4V/4)('/Z. C-0/1/I <br /> CONTRACTOR LICENSE#(REQUIRED): C FM -E.H Cct ViC O CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):01553 <br /> PRIMARY CONTACT: 0 OWNER I�CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> merernv/ Needle( CONTACT EMAIL: , e,;Te hyo, CFM- 11*--) CR. CeM <br /> BUILDING PERMIT APPLICATION / <br /> Existing Use of Building: Contract Price of Work: $ 30oCCCi <br /> Proposed Use of Building: Heat Source: Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: jgkommercial ❑Industrial <br /> Type of Project: ❑New DAddition tilRemodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: C'hajve c - 3 ex;$4(IJ CC - 1:-.% Gli-k Coil fe. Ct 6L:1-ti 3 c' ti Jtirl'1C , <br /> £)ccr-5 tV;;' \ Av Luorlc 4t� d(41i�t;4 on Q it k f- PaA5 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn j(Alteration _Repair Type of Project: New _Addn _Alteration _Repair <br /> #of #of List of Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> 3 A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> 3 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 /> X <br /> PERMIT <br /> iti 'Ow IAuthoyfzed Agent Signature Date c11\ 0 04,.... r),,,00. <br /> (Revised 10/12/2015) <br /> L.-, <br />