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IIIIII II PERMIT APPLICATI�III <br /> BUILDIQG'I MECHANICAL/PLUMBING I SIGN�7 PRINKLER/DEMOLITION <br /> � � CITY OF EVERETT PERMIT SERVICES • <br /> ''IS 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 Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: .- as- O COY 1V /CIO PROPERTY TAX#: aga Li 39 - ppy- .00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATIO N <br /> OWNER NAME: /9.0bA-(2__ f-T.(t\S cs TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1 2 2 . A-5SC 5{vo e C p s 1,..,G VIA y� C7 <br /> CITY tA L jo®®0 STATE Le.)Le.)ry ZIP 0 g 7 <br /> OWNER PHONE: ,9,.(%(' ?9-, 1ZZ� OWNER EMAIL: 'Ali 19-i i?___ "j-•'Q l.. I e_.(4,-rrriC�1 I 6 ,/, <br /> CONTRACTOR NAME: LUQ t-ri- 4)EST a(V Pv\6 t A Gcy '"Tj X <br /> CONTRACTOR ADDRESS: STREET 3 t t 0 16 6 tC- Pl ).i 9_ j€3 <br /> cm, la c in,57:bev STATE (,UA- ZIP 9, _ <br /> CONTRACTOR PHONE: 36,6 653 :w 727 u CONTRACTOR EMAIL: A/Le)f)c,...© &.--01 671. dr ;< \ <br /> CONTRACTOR LICENSE#(REQUIRED): /vb k.' (3i cs k B CITY OF EVERETT BUSINESS LICENSE#(REQUIRE%):05cs 7. 9 , <br /> PRIMARY CONTACT: 0 OWNER RCONTRACTOR 0 OTHER(Please Specify) // <br /> CONTACT NAME: CONTACT PHONE: ti Z _ -0 g ^ q 7 O 1 .,,,,,-- - <br /> /i G©C(!rt f CONTACT EMAIL: Ai P Lo ppm $)U . e_oPo- <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 4 .5 <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: DSFR-Detached HSFR-Attached ❑Duplex ❑Multi-Family#of Units: ❑Commercial El Industrial <br /> Type of Project: El New DAddition DRemodel DRepair DT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: -7 AS TA-t( S-p r t ri,kk,c.f- 5--fs'-rr-.4--- D £ j n c.-k. Zo Thz_ <br /> a L.. lV l=fi t! /3 it S114e-1,bR Ze. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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 #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 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/SUPPRESSION SYSTEM _ <br /> (3 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,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. <br /> City of Everett Official Use Only <br /> y /f PERt rt , q., ,C, , <br /> ‘k,n 0 k-A -60 ( <br /> IT# <br /> Owner/Authorized Agent Signature Date (Revised 5/20/2016) ' <br />