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I <br /> PERMIT APPLICATION <br /> .,— BUILDING I MECHANICAL I PLUMBING 1 SIGN/SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> vilt �,f 3200 CEDAR STREET EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX.425-257-8867 I(E)everettepa©everettwa.gov I www,everettwe•govlperrnits <br /> (Blue or Black Ink Only Ploaase) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: t O S Z Dir' 5e PROPERTY TAX#:00 t6t. evea ePo <br /> LEGAL for new construction: Short Plat/subdiviaion Lot No. (attach copy of long legal description) <br /> I� CONTACT INFORMATION <br /> OWNER NAME: if <br /> a l! v <br /> iii1l TENANT NAME(If Commercial): --- <br /> OWNER MAILING ADDRESS; sraEEr ( 2 () �?Y <br /> CITY Nrig±Q srA-rE /4 vp [��b <br /> OWNER PHONE: 442r240t— CI.1{a5 OWNER EMAIL: ,---,-.. <br /> •CONTRACTOR NAME: r t AJ g' -i-f r <br /> T fi .H 1� "t„ <br /> (/tl t j <br /> j <br /> CONTRACTOR ADDRESS: STREET 111p�I���2_ i f to i rc. 56 - + l ,box f�y'2 )g VT it �T <br /> CITY 1'�'eft �/ STATE (,,�/ f� LIG �O LJCt <br /> CONTRACTOR PHONE: ..^ 1 J CONTRACTOR EMAIL_ t/ C I9'IL t9/' rl <br /> CONTRACTOR LICENSE#(REQUIRB0): w/4itiVi `qu CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER ITONTRACTOR 0 OTHER(Please Specify) - W <br /> CONTACT NAME- CONTACT PHONE: . rg --caw,Vy.c <br /> . / i l lS CONTACT EMAIL: Ga_ �t f t .- W S 6•f LR OM <br /> j�� BUI ING PERMIT APPLICATION _ <br /> Existing Use of Buildin X,, ,( _Contract Price of Work: <br /> Proposed Use of Buildin•; Heat Source:of Units: OCammerciaf Olndu <br /> 0Electric C Other <br /> Buildin•T .e CISFR-Detached O ❑Muhl-Family <br /> Attached Duplex y._. --- <br /> __ <br /> Type a4 ___act:ONew LAddition ■Remodel DRapair DT.I. OSi9n in Sprinkler ❑Demolition OChange of U fes!' <br /> DESCRIPTION OF WORK: <br /> (2 .PIE =40( I0 (Ai akey. <br /> ASSOCIATED SUILOINO PERMIT#(if ap•licabie; <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New_ Addn _Alteration _Repair Type of Project: TNew Addn Alteration _Repair <br /> Flxtu es List of Fixtures Futures List of Fixtures #of List of Fixtures #of Gist of!~fixtures <br /> Fixtures Fixtures <br /> AIC–Air Handling Units Heat Pump T Toilet ,Backflow Pre**(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub . Urinal <br /> Gas Piping W Boiler Lavatory(Wash Basin) Drinking Fountain <br /> tWater Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace .. - 'Wood Stove Kitchen Slnk&Diposal Grease Trap <br /> Gas Range Ducting Dishwasher r Roof Drains __ <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas— <br /> Range Hood _ M Water Heater Other: <br /> Exhaust Fan -- Sink(Service/Bar/Mop/etc.) Other: <br /> • SPRINKLER I SUPPRESSION SYSTEM • - <br /> Number of Heads <br /> ACKNOWLEDGEMENT::J 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.Devietions must first be aUtheri ed In writing from the <br /> Building Official before being authorized under any circu-:once.f am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> ,-,____ p„,,,,,, , ....._ <br /> and I comply with the State Contractors Law 18,27 RC d 295.200A WAC <br /> f City of Everett Official Use Only <br /> a. • <br /> Firer/Authorized Agent Signature Date (Revised 5/20/2015) <br />