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0 • <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwagov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: I V I ►y V E &>✓ S'.?C01 PROPERTY TAX#: 001 /O;�>l DO <br /> LEGAL for new constrUClion Short Plat/subdivision _ _ . Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME T-5 yv L'e bu TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET J g, VI P I/} AV E N(LE q <br /> CITY yf k E t i STATE („RZIPCy �}1 <br /> OWNER PHONE: 1-26-- -76ra — /`J0 ''/ OWNER EMAIL: MIA <br /> CONTRACTOR NAME COk}/U Q �Sro/VF INC. <br /> CONTRACTOR ADDRESS: STREET 17&21 /L1-*'X ^/e yL4,ge C'E #149M Q <br /> CITY t&I E LL STATE k)A ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: �eA SRN Rt JfJlVC?.CGYn <br /> CONTRACTOR LICENSE#(REQUIRED): GORAilr-�OJ_tCl'J ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 033,5 <br /> PRIMARY CONTACT: ❑ OWNER @<ONTRACTOR ❑ OTHER(Please Specify)„ <br /> CONTACT NAME: CONTACT PHONE: x 126_.'185—D/// <br /> SARA ODkA116 R, OFrICE mA/VA&ER CONTACT EMAIL:�q c�Rn1ER15>��ecnF�NG-corn <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building S j✓Q Contract Price of Work: $ <br /> Proposed Use of Building: S F� Heat Source: ❑Gas []Electric ❑Other <br /> Building Type: 6a41R-Detached ❑SFR-Attached ❑duplex ❑Multi-Family-#of Units ❑Commercial ❑Industrial <br /> Type of Pro(ect ❑New ❑Addition ❑Remodel C;Kepair ❑T.I. ❑Sin ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: -Q <br /> RQ,ptaC2 C&��q+�&Y\' L,-J <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 /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures <br /> AIC—Air Handling Units Heat Pump Toilet Backflow Preventer Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Pipinq 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/BarlMo letc. Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT/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 /> PERMI <br /> fawner Authorized Agent Signature 0ate (Revised 5/20/2016) <br />