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PERMIT APPLICATION <br /> BUILDING 1 MECHANICAL I PLUMBING/SIGN /SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettvra.gov/permits <br /> PROJECT SITE lNFORMATION <br /> PROJECT SITE ADDRES5:211I Ir� � C� 't � ,�I PROPERTY TAX#: <br /> li tT <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: G„�a.� ; TENANT NAME(If Commercial): <br /> OWNERMAILINGADDRESS: srae�r 2{�,� �{c�ff' AVL <br /> cm E�e�2I�' srnT� F1 zia �(�Z� <br /> OWNER PHONE: 25 7(9U "I�'l� OWNER EMAIL:jGlel�, ptA�ho t I.CoM <br /> CONTRACTOR NAME:`,�o��f�l IoI�aI LL L <br /> CONTRACTOR ADDRESS: srR�eT Z k4i' S+`I.t'`}- 5�,,;� �A I <br /> cirv eG srnTe lq/'P� ziP �t 3 <br /> CONTRACTOR PHONE: y1S 773 � 345 CO RACTOR EMAIL: so�uf�dm;. Q S�,l <br /> CONTRACTOR LICENSE#(REQUIRE��{: SULTf�I.�3� (j2, CITY OF EVERETT BUSINESS LICENSE#(REQUIR D): <br /> � <br /> PRIMARY CONTACT: ❑OWNER '�I ■CONTRACTOR ❑OTH�R(Please Specify) ' <br /> CONTACTNAME: a ,= CONTACTPHONE: yZS ��3 �$3$ <br /> 2� l?OW` �_` , -" d CONTACT EMAIL: Solc.r d , -I{ff . CUM <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: 3 S� �'/v0 <br /> Proposed Use of Building: Heat Source: ❑Gas '�Electric f'�Qther <br /> Building Type: ❑SFR-Detached �SFR- tached ❑Duplex ❑Multi-Family-#of Units: �"+ , Commercial dustrial <br /> Type oi Project: ❑New ddition prinkler mo ition ❑Change of Us <br /> DESCRIPTION OF W K• u � n �� <br /> u w , , <br /> W <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 Alteretion Repair <br /> �o( List of Fixtures #of Llst of Fixtures #of ��st o/Fixtures #of List of Fixfures <br /> Fixtures Fixtures Fixtures Fixfures <br /> A/C—Air Handlinq Units Heat Pump Toilet Backilow Preventer Inside Bldg <br /> Forced Air Systems Unit Heater Bathtub Urinai <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(ServicelBar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:1 havc reviewed this applicafion and conlirm fhc rnlormatron contained hercin is true and cor�ecf.Work dono pursu�nt to this pomtif mus!comp/y with <br /> cur�onl federal,state,and locnl law.The r�ranting of a pemut oNy authorizes appmved work and no devi�trons therelrom.Dcviations must first be authorized in writrnr�Gom!he <br /> Bui(ding O(licial 6e/ore bornc�authonzed under any circumstanco.I am tho ow�ler.or!am authorized by Ihe ownor n(this prop�rty!a pedom7 the work for which applicatron is made, <br /> and 1 compty with the Stale Contractors Law 98.27 RCW and 29G.200A WAC. <br /> Ciry alEve�ott Of/icial Usc Only <br /> PERM �� ` �O / <br /> /��201'1 � <br /> wnerlAuthorf ed Agent Sig ature Datc (Revised 10/92/2095) <br />