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PERMIT APPLICATION <br /> BUILDIN / MECHANICAL I PLUMBING 1 SIGN /SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECTS IT E ADDRESS: - ve- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: t?tlo Wil ( ) {Ic 'C�fi�YlerL frier'LLC; <br /> TENANT NAME If Commercial : , - .y <br /> OWNER MAILING ADDRESS: STREET �. L1 <br /> CI rYJ U '� '' STATE .�' ZIP <br /> OWNER PHONE: ( OWNER EMAIL: o 6 0 j2s [� <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS: STREET <br /> CITY <br /> STATE ZIP _.. <br /> CONTRACTOR PHONE: -�� 2� t� -'2 CONTRACTOR EMAIL: L `-JT L)L DE'-- <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: [] OWNER RtCONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: C- it Ri j l t JU I �t�,i LJi CONTACT PHONE: l �_ z r I -=� <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: %'t —f Contract Price of Work:$ <br /> Proposed Use of Building 1",-; I) "4 =.-r t 1 ?" r J <br /> Heat Source: ❑Gas tlElectric []Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ncommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition NChange of Use <br /> DESCRIPTION OF WORK: IEIL1NIT M IDLI=Lf"'1= IL I= a I I�I`7TI�L.l_ IG �/�l/�LL"/�r� •�•�I� <br /> J(=Fi�:I� f=0p, taiINEia�4Ro �EIMOVL GISIZ.i�'L.T l:) ` AN� FL.��� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): i �* - =r=- 1Y�^ <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project:_IVew_ Addn ,Alteration Repair Type of Project: _New �.'Addn _Alteration _Repai <br /> #of List of Fixtures #of List of Fixtures #o List of Fixtures # List of Fixt res <br /> Fixtures Fixtures Fixtures Fixtur s <br /> A/C–Air Handling Units Heat Pump Toilet Backflow Prevent (Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub ,Urinal <br /> Gas Piping Boiler Lavatory(Wash asin) Drinking Fount n <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace lWood Stove Kitchen Sink Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drain <br /> Clothes Dryer Hookups Other: Clothes W sher Medical Gras <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink, Service/Bar/Mop/etc,) Other:%- �l i Vt <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Chemical or Water I I No. of He \ <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 feder state,and to al 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 Offs ial before bei 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 /> aLdm /y with the Stat Contr ctors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett official Use Only <br /> f PERMIT# V4 i <br /> OwnerlA oriz Agent Signature <br /> Date (Revised 9/23/2016) <br /> e <br /> Z- <br />