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___0. PERMIT APPLICATION <br /> BUILDS 'MECHANICAL/ PLUMBING/SIPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SER <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 1(E)everetteps@everettwa.gov J www.everettwa.gov/permits <br /> (Blue or Black Ink Orally Please) PROJECT SITE INFORMATICTI .. _.-. <br /> PROJECT SITE ADDRESS: 22_0 1 \bJ`i SW PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: AurevS 1. .1,4„. TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET 'SD '1 Avg <br /> coy e..,ere.ki- STATE 1,.)A ZIP Gi g2 03 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: i/I1TC.pl A ( \-eakeLA-kct i 5o k,ki o✓ _S LLQ <br /> CONTRACTOR ADDRESS: STREETrr -f�``2" .41 i Ave !J C <br /> L <br /> CITY A.tel Si ,V€meg STATE t,JA ZIP ie25-78 <br /> CONTRACTOR PHONE: r CONTRACTOR EMAIL:I cc oo/1k A try 9�d M5-, [i ,'2 <br /> CONTRACTOR LICENSE t(REQUIRED) iA. 45 ga N CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) alifk et <br /> PRIMARY CONTACT: ig OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: t.{2c_3 col-71 518 <br /> e(\ Cook, CONTACT EMAIL: A Cco,je•45 tnkeo l cS MS.b i Z <br /> ; <br /> fr BUILDING PERMIT APPLICATION <br /> Existing Use of Building: L)�eylo_5el af-,`ce S Contract Price of Work:$ <br /> Proposed Use of Building: y,.rI 4 _/ of-c-:•ce5 Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: tiCommercial ❑Industrial <br /> Type of Project: ONew DAdditionRemodel DRepair DTI. OSign ❑Sprinkler ❑Demolition DChange of Use <br /> DESCRIPTION OF WORK: \erA6 esti b nc, acs ac,,s je3rv..e.Se (3) b\le-k'S c(rA CA 1--AU-i. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): Si b 0 I-O1' <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 #°f List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump 3 Toilet .Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Z Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower 1 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 I Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER!SUPPRESSION SYSTEM . <br /> Number of Heads <br /> ACKNOWLEDGEMENT:1 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 l 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 /> City of Everett Official Use Only <br /> V' — / S ZD 10 <br /> PERMIT# <br /> le( 0'7 - 110g <br /> `Mr/Authorized Agent Signature Bate (Revised 5/20/2016) <br />