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PERMIT APPLICATIO <br /> 'llIlli BUILDINCHANICAL / PLUMBING/SIGN / INKLER/ 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 /> ,,i----E--::- PROJECT SITE INFORMATION' - <br /> PROJECT SITE ADDRESS: G I fi 1-7N., PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION ' <br /> OWNER NAME: VV L\k-it TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: 9 OWNER EMAIL: <br /> CONTRACTOR NAME 5(V) /f l---p <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: D OWNER D CONTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME:���'�/ r CONTACT PHONE: (4-1A- `2$ -�P "C3 <br /> LAU -v` t `2 V CONTACT EMAIL: }� �y(2_, tiA 21.044 tido -`tel ,T�e'f`) <br /> BUILDING PERMIT APPLICATION ' <br /> Existing Use of Building: (P 1'' �� Contract Price of Work:$ 011 I t l t..--, <br /> Proposed Use of Building: --(j-- I P 1i l— Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: L*.ISFR-Detached ( S, -A/ <br /> F,,�RAttached ❑Duplex ❑Multi-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ONew ❑Addition UK-model ❑Repair DT.I. DSign CiSprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: 14 -.1 tLK, To . z --A-o P-&-1.— p1(2-4p()/tic.I K <br /> ASSOCIATED BUILDING PERMIT# i plieabte)-- ; , <br /> MECHANIC " ERMIT APPLICATION PLRM <br /> UMBING-PEIT APPLICATION' \! <br /> Type of Projec• New _ Addn _Alteration _Repair \ Type of Project-- New _Addn Alteration Repair <br /> #of #of List of Fixtures List of Fixtures #° List of Fixtures #of List of Fixtures <br /> Fixtur Fixtures Fixtur•s Fixtures <br /> NC—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 /> PRINKLER/SUPPRESS SYSTEM <br /> eads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true- . . - . ""or 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 Contr. tors Law 18.27 RCW and 296.200A WAC. <br /> 41, ill <br /> City of Everett Official Use Only <br /> I 4,\ <br /> � I, 4 �1� J2-01 <br /> r j PERMIT# ��( �Q05:06)---r. <br /> Owner/Au•h.ri e. Agent Signature Date (Revised /12/2015) rs` <br />