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OLT • PERMIT APPLICATION/ <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3O UF)q iiv` A Ip PROPERTY TAX#: 03113 3(�c L <br /> LEGAL for new construction: Short Plat/subdivision VVV Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:g( y e� 75�k.Q�� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET II 20 Co J pd 0 gel /)�y-� (�/,f�T' <br /> + J CITY CiK/ Ivv► STATE �I i' ZIP lU2 �v <br /> OWNER PHONE: 1 ZS �o \ 9 OWNER EMAIL: Jtpl , S 1,,•`e,ds e Ft (Ake._c(°ivk <br /> 4-- <br /> CONTRACTOR <br /> CONTRACTOR NAME: <br /> (/ <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> II <br /> CONTRACTOR PHONE: 'CONTRACTOR EMAIL: _ <br /> )----- - w 71 -----r r-,. w i _ I - J <br /> CONTRACTOR LICENSE#(REQUIRED): :ITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> - - <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NA E: tJ • CONTACT PHONE: ._9 -F Lf/5 601 2,1 ciL <br /> �•J`t��`�1 L• / CONTACT EMAIL: <br /> ,�,� "I BUILDING PERMIT APPLICATION <br /> Existing Use of Building: VLSI(jQ H Pi2j` Contract Price of Work:$ J3,,T5.---' 5 II <br /> Proposed Use of Building: I ,Heat Source: ❑Gas lectric ❑Other �';,v Sloe_�- <br /> Building Type: DSFR-Detached ' 1SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial CI Industrial <br /> Type of Project: El New DAddition DRemodel epair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> (21,,A,0 A ),_ iv\ac-,2 ytD01- cANA (0 k*Arj 124•) errAI) ft 9 0, 1--5 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): W- 0,4-G'" ► '" '" J <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New Addn _Alteration _Repair <br /> #of List of Fixtures #°f List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet 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 /> Number of Heads <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 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 um z 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 I comply with the State Contracts' 18.2 CW and 296.200,4 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> All , , <br /> i 11-'--- 0 PCI(,Z ` 2C)i‘' W I (o II --Ob l <br /> 1 •wner/•uthorized Sinatu Date ' (Revised 5/20/2016) <br />