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II, I PERMIT APPLICATION <br /> BUILDII4/MECHANICAL/PLUMBING I <br /> SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ' ' l 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: 'j"���, Lje r(}if-A.41 (,- PROPERTY TAX#:(^�(� cl 3 2 n6 o 1�®o <br /> LEGAL for new construction: Short Prat/subdivision J Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: OrAtIr is,Q S North Wt7s+ wit TENANT NAME(If Commercial): va ! v t ns <br /> OWNER MAILING ADDRESS: siREEr jD 0 a, '-f b u <br /> CITY gI. J f v 1�,�.�[,� STATE � ZIP 2,70 <br /> OWNER PHONE: I r OWNER EMAIL: <br /> CONTRACTOR NAME: C__; `I-\( 4,i(�j((] Q,;c('j <br /> CONTRACTOR ADDRESS: STREET j (� � (c,71 <br /> CITY �j p(�..1)Gl.W, `,. STATE " ZIP 9 , 8-7 <br /> CONTRACTOR PHONE: iO io -17 (a CONTRACTOR EMAIL: J€ Q,6- yS vi Saroi(SL&M <br /> CONTRACTOR LICENSE#(REQUIRED): GI`'l y5" g-'7 J CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify)_ptfrfl+l`v f fEC,ft <br /> CONTACT NAME: ra(4 4s I v199,t' CONTACT PHONE: S3 - a p Q'--- S` 7 <br /> 1 CONTACT EMAIL: -']--pas h l D t (/YICcc I Co ry <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Mob', I L&hL- Contract Price of Work:$ 0 0 01 <br /> Proposed Use of Building: V Ct\O© y\,Q,,. Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: g'Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ,Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: `c mf l 1 <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 /> 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 /> SPRINKLER/SUPPRESSION SYSTEM <br /> '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.lam 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 /> -- "' PERMIT# <br /> -7-7-/y-/6 S 1,6f-07- 007 <br /> Owner/Authorized Ag rt Signature Date (Revised 5/20/2016) <br />