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6idal7y yor y <br /> 410 PERMIT APPLI(ATIO: <br /> BUILDINta.I MECHANICAL/PLUMBING%SIGN; SPRINKLE I DEMOLITION <br /> lovatiego. <br /> CITY OF EVERETTT PERMIT SERViesEt <br /> a ' ` 3200 CEDAR STREET,EVERE I i,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-3857 i(E)everetteps@everettwa.gov I wvw.everettwa.govfpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> , <br /> PROJECT SITE ADDRESS36400 int.i 1 A. PROPERTY TAX#: .90 5 Z C!?.....r; <br /> 11...:0 0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No, (attach copy of long legal description) <br /> CO NTACT, NF�ORMATION <br /> OWNIyR NAME: .S S (—On ' t.'! c,rilAei TENANT NAME(If commercial): pi € 111,4 Si .e.-t SJR fr.r <br /> OWNER MAILING ADDRESS: sTRecT 3(,at .:5;w,y-l- ` ,,,; <br /> cir i_v�<<.. STATE tom'4 C O <br /> OWNER PHONE: 5L., 3. ,�, - jam/ '1 OWNER EMAIL; L-t‹,C. 5.-,i,VI4S i . ; "cL :"'`M Al,CG r't <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY' STATE �23P <br /> CONTRACTOR PHONE: GONTRACTOR,EMAIL: <br /> CONTRACTOR LICENSE#(;REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED); <br /> PRIMARY CONTACT: 6WNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: t ,_ c.J-i r <br /> tLe ..-,'l "‘i.--, = CONTACT EMAIL: L-^r & .,+,-.. y <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ r,%:- A 17_,:-.7,5-'" j03 k 14 t I''i <br /> Proposed Use of Building: HOtSpurce: ❑Gas ❑Electric ElOther <br /> Building Type: EISFR-Detached ❑SFR-Attached ODupiex DIVIult3.F miry-#of Units: ��,r OC.ommeic al Dlndustrial <br /> Type of Project: ONew OAddition ORemodel ❑Repair DTI. ❑Sign OSprinkler k7t)emolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> .fkvt 6g (V\ \\ Z --- )\ , -- Mid( Of=f <br /> ASSOCIATED BUILDING PERMIT (if applicable): ( _1 SC s°F.:) <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New ! Addn AlteratIon _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of #of #of #of <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC Air Handling Units Heat Pump Toilet Backflow Pre tier(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater RefrigerationShower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal `Grease Trap <br /> Gas Ran9e Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas . <br /> Range Hood <br /> _ Water Heater Other: <br /> Exhaust Fan Sink(ServicefBaiihitopietc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT'I have reviewed this application and confirm the information contained herein fa true and correct Work done pursuant to this permit must comply with <br /> current federal,state,and focal law,The granting of a permit:only authorizes approved work and no deviations therefrom.Deviations must first be a.4thorized in writing from the. <br /> Building Official before being authorized under any circumstance. I am the owner,or I am authorized by the ownerof this property to perform the work for which application Is made, <br /> and I comply with the State Contractors Law 18,27 RCW and 296 2004 WAC, <br /> City of Everett afficiai tdse Only <br /> T# <br /> PERMIT <br /> , _ -- ''' - > . ,P (coo"7-oo l <br /> Owner/Authorized Agent Signature Date, (Revised 5/20/2016) <br />