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MIT APPLICATION <br /> BUILD! /MECHANICALS`4577- ----.c. <br /> DUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> -- ----: EVbRETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> 1(BIue or Black Ink Only Please) PROJECT SITE INFORMATION ' <br /> PROJECT SITE ADDRESS:?FA+ cr(c32c2` PROPERTY TAX#: <br /> • <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: k''� j ,04c( TENANT NAME(If Commercial): 11'41 <br /> OWNER MAILING ADDRESS: STREET 2 44)0 •Ma <br /> crit X-i t Nva{ STATE ZIP �z4 <br /> OWNER PHONE: 40.63S5 4tc L/ OWNER EMAIL: �c - � Qcv� '�� . (F.(i <br /> • <br /> CONTRACTOR NAME: -I <br /> . Of \ l i yA 1p G i° Jo lrizt ` ' —( <br /> CONTRACTOR ADDRESS: STREET C1��11 <br /> Crry STATE <br /> ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: r/� ) 7 ' <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESSt�CLICENSE#(REQUIRED): r� C 7 C2} <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR MOTHER(Please Specify) 7'476 Ht Iv✓r <br /> CO�yNTACT NAME: <br /> rf,.,� CONTACT PHONE: wl4 44-1 -462'Z�' <br /> I 1 etr- �s� CONTACT EMAIL:\MO. Rq cAvg x,T' r <br /> BUILDING PERMIT APPLICATION 7�"G�� <br /> fAA rn � t"'1 { 1 - ! ( 7-7 <br /> Existing Use of Building: 110 LWT 'j(�-1j�V Contract Price of Work:$ -: d (__ <br /> IProposed Use of Building: VA.IDVI, .6C __. Heat Source: Deas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ,Commercial ❑Industrial _ <br /> Type of Project: ❑New DAddition�� EIRemodel ❑Re�paair�)- .I. ❑Sign`n❑Sp�rinkller ❑0Demolition ❑Change of�Use ',� <br /> DESCRIPTION OF WORK: ...12,(4.1460--t,. <br /> I 3 .o6�`"i'T� C.� jJl`"ec "'S v'espi7 i cks <br /> 10 C1u,Sci J L m>j- Y1n6p tai, l J 6+‘) U1n,St•- • L -p ch`E <br /> Pr (ts j aeric* 4 Y11/441, c c.-. <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 /> #of #of #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> 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 I GCV k(.,y'' / Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I No.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 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> I �City <br /> offEverett Oficial Use On <br /> ly <br /> Ti/ , 6/7P7 <br /> q 7 L Eve7 —co ( <br /> Owner/Auth.rized Agent Signature ate (Re ised <br /> 9/23/2016) <br />