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PERMIT APPLICATIOP <br /> /11".- .-4 BUILDIMPM1IECHANICAL/ PLUMBING /SIGN RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ,fillif <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> : PROJECT SITE.INFORMATION <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: <br /> 1005 `Pa,c.,"cee. Av4. <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT,INFORMATION . <br /> OWNER NAME: Pv.1..4 SovI.A.A. 14"4aei Cer161" TENANT NAME(If Commercial): f 4G <br /> OWNER MAILING ADDRESS: STREET I OM PaC S".. Ave ^ <br /> ern(trv.e.r STATE WA ZIP %ID j <br /> OWNER PHONE: BIZ'; -7.5-1— 5(c1S OWNER EMAIL: <br /> CONTRACTOR NAME: Nev./14,4A COOS+rvc#r 6-0v01 PAM 1 <br /> CONTRACTOR ADDRESS: STREET 33tsa Unes+tiv► 5+ <br /> cm, Earczegji- STATE WA ZIP 'YelZ,/D` <br /> CONTRACTOR PHONE: 4-Z.S. —1...5c — ci 1 l CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): <br /> CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 61 F C,c)E <br /> _ .. . <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR OTHER(Please Specify) ArcAA(&cd- <br /> CONTACT NAME: �O CONTACT PHONE: �ris.rate�' 1na�tk.crsw‘ <br /> G�Yis go,c..c. <br /> CONTACT EMAIL: 14,1, -zscc-a8(0% <br /> BUILDING=PERMIT APPLICATION .. <br /> Existing Use of Building: k,Avu¢u) p.Aw'4,:5 CA i n i[. Contract Price of Work:$ 31 q x I cQ9 .D O <br /> Proposed Use of Building: k,'aveb i Ak l,,f5 CAr cilia Heat Source: LGas DElectric ❑Other <br /> Building Type: ❑SFR-Detached til SFR-Attached DDuplex ❑Multi-Family-#of Units: L'7Commercial CI Industrial <br /> Type of Project: CI New ❑Addition EfRemodel DRepair DT.I. DSign OSprinkler ClDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: -61 1 <br /> elk &wsi-,..4, itt�e!'i of. EA -d.o - Ciof Sfait. -A.3 Sw,All e.MA1 Ad 44-1-,-", <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 List of Fixtures #of List of Fixtures <br /> List of Fixtures #of List of Fixtures #of <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 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. City of Everett Official Use Only <br /> PERMIT# <br /> ,/"' D 2., �(l2C5`nc3C/ <br /> —�• I� .. Date (Revised 10/12/2015) <br /> Owner/Authorized Agent Signat 1 e Z— <br />