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0812512016 10:00 BEL RED ENERGY SOLUTIONS (FAX)4254935354 P.0031003 <br /> PERMIT APPLICATIO <br /> BUILDING ) MECHANICAL/ PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> OLCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everettepsQaverettwa.gov I wwv.everettwa.gov/permits <br /> Blue or Black.ink Only Please PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: OOS 44L1-JbAg0 LJos <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STrteeT , t <br /> CITY STATE W IPS- ZIP <br /> OWNER PHONE: OOZO IOWNER EMAIL: <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS: smear L <br /> CITY�t l)� tJ STATE ZIP <br /> CONTRACTOR PHONE: y25*" �a' �35� CONTRACTOR EMAIL; iA `, <br /> CONTRACTOR LICENSE##(REQUIRED):-te%9.et.S SVbO r' CITY OF EVERETT BUSINESS LICENSE#(R UIRED): OH62- Sg <br /> PRIMARY CONTACT: El OWNER ❑ CONTRACTOR OTHER(Please Specify) a <br /> CONTACT NAME: CONTACT PHONE: L{.'Zr, — <br /> ( � t�ay.c—�a �t �,^ CONTACT EMAIL; 6 UL►k A, CAS--- <br /> BUILDING PERMIT APPLICATION <br /> ExistinQ Use of Building: Contract Price of Work; $ 0 , Op <br /> Proposed Use of Building: Heat Source: ❑Gas ectric ❑Other <br /> Buildin T a: ❑SFR-Detached FR-Attached []Duplex ❑MuIG-Famll -#of Units: ❑Commercial ❑Industrial <br /> T e of Pro ect: ❑New ❑Addition ❑Remodel a air OT.I. ❑Sin ❑S rinkler CIDemolition ❑Chan e of Use <br /> DESCRIPTION OF tWORK: (� <br /> �,✓�ST[�e.00 �l GGt��G wa-►� �'EC�(L, <br /> ASSOCIATED BUILDING PERMIT# if a licabla): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _Naw Addn _Alteration _Rapalr Type of Project: _New _Addn Alteratlon opair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> AIC-Air Handlin Units Heat Pump Toilet Backflow Preventer inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Plplrg Boiler Lavatory Wash Basle Drinking Fountain <br /> Water Heater Refrigeration Shower Floor brain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ductin Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: i Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink (Service/Bar/Mop/etc. Other: <br /> SPRINKLER/wPPRI=SSION SYSTEM <br /> Number of Heads <br /> ACKrvOWLE001WENT,1 have reviewed this application and confirm tha reformation contained heroin is true and correct.Work done pursuant to this permit must compty with <br /> current federal, state,and local law. Tha granting ora permit only authorizes approved work and no deviations therefrom.Deviations must tlrst be authorized In writing from the <br /> Building Official bofom being authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this proparty to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 286.200A WAC. <br /> City of Everett Official Use Only <br /> Of <br /> P R IT r/'14DS <br /> Owl ut oriz Agent Signature Date (Revised 6/20/2016) ' <br />