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PERMIT APPLICATIC <br /> BUILDIIM I MECHANICAL/ PLUMBING /SIGrPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or_,Black InkOnlyrvPlease)a ,, PROJECT SITE INFORMATION:it-',511,55-t: ,, <br /> PROJECT SITE ADDRESS: 2201 1Q0 .S ,SW PROPERTY TAX#:.2g 6j©1 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> z ,`CON,TACTrINFORMATION„ _ _. <br /> OWNER NAME: AuYjyq, •SpSte/1^'L. Ti�G TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 220I jOO t41Si- �'-✓ 1 , <br /> CITY EV��i7, STATE k/{/1' ZIP a 22014 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Perri dt Fire Prot- -roi4 <br /> CONTRACTOR ADDRESS: STREET 2-7Q7 70141 Aft, <br /> CITY F.-We STATE VV M ZIP ct <br /> CONTRACTOR PHONE:Z5 3- 9.2.6' -,22q© CONTRACTOR EMAIL:dq,Vir .G�rlS7`CriSoH(ilOG�1 0t u <br /> CONTRACTOR LICENSE#(REQUIRED): PAT -�IC1�OcrcI GF CITY OF EVERETT BUSINESS LICENSE#(REQUIRE .(J�Z,�6R�-1 <br /> PRIMARY CONTACT: 0 OWNER ria .ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT^^�� NAME: CONTACT PHONE: 5'23 - aa6 -z2g0 r <br /> 1✓avIN c ir-13j�enroe) CONTACT EMAIL:dc4 �y� , Cieat-6'4.5'0i4a,§0. -riO�`fi✓e•cow, <br /> BUILDING PERMIT APPLICATION ` s . ,., <br /> Existing Use of Building: ?DSt Office -ordrActryc hmZa.rd Contract Price of Work: $21/ 55 6•S0 <br /> Proposed Use of Building: Glti4.-e. - (fJt ht 1i.aZa ec/ Heat Source: ❑Gas ❑Electric,,..,.// ❑Other <br /> Building Type: ❑SFR-Detached ❑S.F.,R/-Attached ❑Duplex ❑Multi-Family-#of Units: I(r6ommercial CI Industrial <br /> Type of Project: ❑New ❑Addition IJRemodel ❑Repair [131.1. ❑Sign 132prinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ,#vt°day& exr tr19 Sior/lrtktr- sycf-er 40 1010-0 eGt ✓ie v wtez,7_o4,elrne ah off <br /> uzoti( able ceiIrri\y tovou t• <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> . rf, MECHANICAL'PERMITAPPLICATION 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 #of List of Fixtures #of 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 /> S ,RINK ER/SUPPRESSION SYSTEM `: <br /> Number of Heads <br /> ACKNOWL DGEM T: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 fede st ,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. s� <br /> City of Everett Official Use Only c �,1 <br /> PER�L \ ,(e k. L 1 <br /> ArlAlui(lorized <br /> C.�D dve%1 e,A i/ 16 `�O9 Agent Signature Date (Revised 5/20/2016) <br />