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PERMIT APPLICATION <br /> BUILDIN MECHANICAL / PLUMBING / SIG� PRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERV L� , <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black ink Only Please) PROJECT SITE INF44MATION <br /> PROJECT SITE ADDRESS: zZ t5 Wes� CQfi no �`Da� PROPERTY TAX#: 2101690 2 o[6 oo <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: SN (Nf�[jTrvtr)./T e1Z0yk"12-1 liE( LLC- TENANT NAME (If Commercial): 'And (C 2R a. <br /> OWNER MAILING ADDRESS: STREET 1/2/ Su/ S*4h4ON <br /> CITY PO INT L-AW7 STATE O t2 ZIP ( T ZOO <br /> OWNER PHONE: 503 -LqZ — 7-g00 1OWNER EMAIL: <br /> CONTRACTOR NAME: Un. I" Ae~ rk eA,&nl Gq <br /> CONTRACTOR ADDRESS: STREET (I�®o /�r py-'f— K/a% �k f-A �z XV-'Z- <br /> CITY <br /> Vti <br /> CITYJ2q to f-tC STATE 10'� ZIP <br /> 1 ((g <br /> CONTRACTOR PHONE: �� J O3(o CONTRACTOR EMAIL: 7 o„iD U-r-MC'C Aq'7 Ca <br /> CONTRACTOR LICENSE#(REQUIRED): ("4"TES wl 962-Q q 1 CITY OF EVERETT BUSINESS LICENSE#(REQUI (D): <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: 1-0 (rte, l e d4 CONTACT PHONE:62-916 <br /> a CONTACT EMAIL: us _s47eAan;cq 4 CO�Lt <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: (�✓GrGho yrt Contract Price of W : $—Z 48.0_00 <br /> Proposed Use of Building: Wd a tioufe Heat Source: ❑G s ❑Electric 0,0(h e r N h <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units. ommercial ❑Industrial <br /> Type of Project: El New MAddition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Add a vw i,7_�i�c �� ti a�S� ��� Cr�Aujf <br /> de,onet✓' .rl,.a,d will �Limi�a on hood. <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 /> 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 /> Chemical or Water No. 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERM 3 <br /> T <br /> ti►,', 7 , I17 r 1 L Z <br /> Owner/Author&ed Agent Signature Date (Revised 9/23/2016) <br />