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OLTPERMIT APPLICATION <br /> BUILDING I MECHANICAL / PLUMBING / SIGN /SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: Io2A0 lq� �5 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 6r, O U-jr S.At_,E TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 107_00 1rtie Pf l--S e._ <br /> CITY 61“,O"T STATE LA.Silk ZIP 1.V 2 o' <br /> OWNER PHONE: 4Z5 3t2, $1Od OWNER EMAIL: SAyC.CC$a,(.ISX)6=0-K..,►^¢IILT[O/J. CO t'% <br /> CONTRACTOR NAME: S r..-(1.4,6). .-1 CE1.1S-titares>j'1,0 Al/ (+JC . <br /> CONTRACTOR ADDRESS: STREET q <br /> CITY $(ill-VD <br /> E• eQue. STATE W1Pr ZIP 9ZCI)S <br /> CONTRACTOR PHONE: 425 T 1*4. rll- OO CONTRACTOR EMAIL:�lc ece.p4s1JSO,..y...0.4s-r0 cT(O N. cavy <br /> CONTRACTOR LICENSE#(REQUIRED): -0.0.(4%.1/4)G=8eSCE3LA CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):O\4:13J5 <br /> PRIMARY CONTACT: ❑OWNER 21,CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 'Z O(0 ZS 5 '3 037_ <br /> • obit1 l -J—Ac (L. IC CONTACT EMAIL: .,. (4.%4 L@. .eje..LnIUSO.JCG VRs/c.TLbt 1 Cep <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: QE.TH-w_ Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: IiGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Iommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition KRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 12e.1vx:.0EL- OFx tstit.k -?-rsr+SS-e(L4 E eA. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ..B15061—01-kca% <br /> MECHANICAL PERMIT APPLICATION y-PLUMBING PERMIT APPLICATION <br /> Type of Project: _New K Addn )Alteration Repair Type of Project: New _Addn Pc Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units Heat Pump Toilet 2 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 Z. 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,a .local law. T.-gr. ting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official bef.e beng au ho' ed un•er 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 e Ste: 'on. :actors L2. 8.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> I1 I � � X «12O1 - ODS <br /> Owner/.uthori d Agent Signature Date (Revised 10/12/2015) n <br />