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PERMIT APPLICATION <br /> t.,�,4orib BUILDING I MECHANICAL I PLUMBING/SIGN I SPRINKLER I DEMOLITION <br /> ill <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 /> (Blue or Black Ink OnlyPlease) PROJECT SITE INFORMATION,,--- J3JJ <br /> :1CJ !`q 3 <br /> / <br /> PROJECT SITE ADDRESS: C 0 ac) .-? /7 v- ser„- cligza. %ROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 144VA t1 C-4- m I`(&& .7,\:epi,:-/- 7 r/-TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREET?0 (3c-1K t.3 al 49, I 1v <br /> crrY �--ek_e-cc- W <br /> STATE : ZIP <br /> OWNER PHONE: 4z.5—1p t D `-3 j fp 7 - OWNER EMAIL: 6 ('f'&.. 0 BLAS S1 c?- ( -t?s . Com <br /> } < 1-az i\GW i t . .,:e:;/.7C IC- t\ <br /> CONTRACTOR NAME: I� q� LLC...{{{ �/�Q� 1 �'' 7� <br /> CONTRACTOR ADDRESS: I STREET 3�� J� t�-te-`>LA,-; ,...0„'d' I ` <br /> E'te 4;\:. <br /> Pt <br /> STATE ZIP <br /> CONTRACTOR PHONE: NI T t CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> . <br /> PRIMARY CONTACT:CAdWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: --� <br /> /3e*. <br /> CONTACT PHONE: L _ — (r (C-'-�I5�7 <br /> 7j {✓,C 'DA CONTACT EMAIL: jO.e.CV NA.l,) Sf"e'`'^c t'6 :"C". CM r`l. <br /> BUILDING PERMIT APPLICATION p -� <br /> Existing Use of Building: fl Pt IZ 7-re,e,' fS <br /> f l' Contract Price of Work:$ - 10 C 6 <br /> Proposed Use of Building: v iRec7O Heat Source: ❑Gas lectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ;81Commercial El Industrial <br /> Type of Project: ❑New ❑Addition no,._--'-' '-'"-pair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition Change of Use <br /> DESCRIPTION OF WORK' <br /> - tcNriiJ E. UNLWc(.'L ilk f U(ir M11- <br /> f ASSOCIATED BUILDING PERMIT#(if applicable): (1OA- <br /> G l N l <br /> MECHANICAL PERMIT APPLICATION Win-` PLUMBING PERMIT APPLICATION /VI--/.-'-- <br /> Type of Project: _New Addn _Alteration _Repair/ Type of Project: _New _Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of 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 I 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.lam the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.20 A WAC. <br /> `'c ,�, ,/.. City of Everett Official Use Only <br /> v / 1".. SI/ae0614 ‘e S-! <br /> Own rf PERMIT# N noS <br /> � I <br /> ��fz Agent Signature �/( Da (Revised 9/23/2016) \ <br /> g Z7 <br /> r a.._2) <br />