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PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING /SIGN /SPRINKLER l DEMOLITION <br /> CITY OF EVERETT t5ERMIIT SERVICES <br /> 3200 CEDAR STREET.EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-$$57 1(E)everetteps@everetfwa,90V I www.eveMttWa.guvlpermits <br /> slue or slack Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: lJPROPERTY TAX#: <br /> LEGAL for new constructlon: Short Plat/subdivision_ Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �y TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1 /a — (///'�}r <br /> CITY 'U e e- 1 STATE rip <br /> OWNER PHONE: Al, G OWNER EMAIL: <br /> Q 't . <br /> CONTRACTOR NAME; �A1> 5�#(h1G7-Tb N f� f2�5 <br /> CONTRACTOR ADDRESS: STREET 1-7115)J - I(Lo ll- A-II '^ X ICU <br /> CRY l 16�T y STATE ✓ YIP / <br /> CONTRACTOR,PHONE: q2,6—W3— p p CONTRACTOR EMAIL: IlIY I L+ t U�I <br /> CONTRACTOR LICENSE#(REQUIRED): li(���gp i 4 CITY OF EVERETT BUSINESS�.iGENSE g(PEQUIRED): <br /> PRIMARY CONTACT: D OWNER CQNTRACTOR ❑OTHER(Please Specify) <br /> /07 <br /> CCON�ACT NAME• p ( CONTACT PHONE: <br /> 4J ( CONTACT EMAIL: W"'J' Ht f (7f� L• C I <br /> BU1 AINO PERMIT APPLICATION <br /> Existing Uso of Building: OS Contract Price of Work:$ <br /> Proposed Use of B Idin : Heat Source: ❑Gas ctric ❑Other <br /> BuildingTe: R-Detached ❑SER-Attached ❑Duplex ❑Multi-Famil -#ofUnits: 00ommercial ❑Indu +$f <br /> e of Pro'act: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. []Sign _ ❑S rinkler ❑Demolition l�]Change of U e <br /> DESCRIPTION OF WORK: <br /> &o o\t c�- t241, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project; JN®w ___Addn _Alteration _Repair <br /> #of Ust of Pixtures #4f List of 1"ixtures 4 of List of FIXturvs #of List of Fixtures <br /> Fixtures Flxtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet I Backflow Preventer(Inside Bldg: <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Roller Lavato Wash Basin Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&018 oral Grease Trap <br /> Gas Ran a Ducting Dishwasher Roof Drains <br /> Clothes D er Hookuos Other. Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWL>00(;)501 Mr.-1 have reviewed this application and conflrm the information contained herein is true and correct.Work done pursuant to flus permit must comp Jr with <br /> current federal,state,and locaf law. The granhng of a permit only authorizes approved worN and no deviations therefrom.Deviations must Ifst be authorized in writing from the <br /> Building Official before being authorinor underany&cumstance.t am the owner,or ram authorized by the owner of this property to perform the work for'which appiic0on Is mat <br /> 1 comply win the State Contractors Law 18,27 RCW end 296.200A WAC. <br /> City of Everett Official Use Only <br /> L� �/17 I <br /> PER II�] 6 <br /> ownedAuthorized Agent ignature Date (Revised 5 12 012 0 1 6)U <br />