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0 0 <br /> PERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> OL (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I kwiw.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS- 2 2 I C"P L S-1— 1PROPERTY TAX#: 00 41 7)0006 -Y706 <br /> LEGAL for new construction: Short Plat/subdivision __.....Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: at yn 6-4" LA 1,taa- TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> cfry V ewe:�I— STATE A ZIP9T 20 1 L2-6 <br /> OWNER PHONE: jo3 l -,'j-7 3 f? 1OWNER EMAIL: 44'a- <br /> CONTRACTOR NAME: a 5 eIr V"I;-e- C- <br /> CONTRACTOR ADDRESS: STREET <br /> fi2 23 <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: --1,60) 103 - 05-(5- CONTRACTOR EMAIL: 0 C-4 in C i(G.c-T'`t C <br /> CONTRACTOR LICENSE#(REQUIRED): A(jFR=-+ 037VAC I ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED). 01 Ll 0'y <br /> PRIMARY CONTACT: 0 OWNER 4n'CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: I CONTACT PHONE: 366 1 0 3 —,9S%S-- <br /> 11-nKITArT EMAIL: ecrll' a J <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: lContract Price of Work:$ <br /> Proposed Use of Building: lHest Source: 0Gas; DElectric DOther <br /> Building Type: CISFR-Detached --0'5FR-Attached ODuplex []Multi-Family-#of Units: ElCommercial Oinclustrial <br /> Type of Project: 0 New OAddition E]Remodel EIRepair EIT1 E]Sign OSprinkler DDernolition OChange of Use <br /> DESCRIPTION OF WORK: q0 a fie 50 6 r 7 6, <br /> JASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn —Alteration _Repair Type of Project: —Now —Addn —Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures I Fixtures <br /> AJC-Air Handling Units Heat Pump IToilet 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 /> JChemicai or Water I JNo.of Heads <br /> ACKNOWLEDGEMENT:/have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permitmust comply will) <br /> current federal,state,and focal 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./am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.2 Wand 296.200A WAC. <br /> City of Everett Official Use Only <br /> ��G��'G��`�._, c�fZ ,-t ,� PERM R-r-, <br /> Owner/Authorized Agent Signature Date (Revised 9/2 O16) <br />