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(4) <br /> . . .(*ten. PERMIT APPLICATION <br /> BUILDIN ECHANICAL/PLUMBING /SIGN /UI I IINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 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: ( 5D EV e r-QiScan WQ\I C-(®1 PROPERTY TAX#: WMCO('Lj] <br /> LEGAL for new construction: Short Plat/subdivision J Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION ,� J�� <br /> OWNER NAME: -T-rpt-)N � 't a\ TENANT NAME(If Commercial): &_I( CC�Y/ <br /> b ' 1�CA <br /> OWNER MAILING ADDRESS: STREET <br /> \�' y p e)( r�('� WC(' <br /> S C~k p1 <br /> CIT' V e.\ '�'�k- '1 STATE A ZIP 9V1) <br /> OWNER PHONE: 4 2,vqmo OWNER EMAIL: peipr rn('12.�^(Y1_SY\ - (c rvm <br /> CONTRACTOR NAME: ntLint)p\r4 ( Ie sera' convactrsLuc, <br /> CONTRACTOR ADDRESS: STREET 7\,U® Mad\C r - l//�� (/�� <br /> CrTY Evert* STATE wA ZIP /6620. ) <br /> CONTRACTOR PHONE: 4?G):2-A—I ( CONTRACTOR EMAIL: \e. (a_ CSI Up (� M 'OW) <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): D11;05� <br /> PRIMARY CONTAB .OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME , e CONTACT PHONE: 4' _2A9-)90r-r) <br /> I� y MC1�1V1NAN( CONTACT EMAIL: IKAttYle-.l2@ rv\S'1 •CorvI <br /> BUILDING PERMIT APPLICATION ttrr11 <br /> Existing Use of Building: C aKee,1 err LO L ,► skv-p Contract Price of Work:$ k 0 i VbD. ` , <br /> Proposed Use of Building:i1o„SzANV')�', .es\-- �urQ�Heat Source: ❑Gas ❑Electric ®.Other 1-t-I?OL �c�vAMQ <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: giCommercial ❑Industrial <br /> Type of Project: ❑New ['Addition gRemodel ❑Repair ❑T.I. ❑Sign ['Sprinkler 'Demolition SaChange of Use o(,�?�0 ?j <br /> DESCRIPTION OF WORK: JMr q Q \e_® � Q co6oA -S ) GvdC 1 n.41 e\vCS a <br /> r <br /> \-�- a h/r-eSta.vi`V-G�YI+ -equ i pmen+- ins �� N6,w tr,c-M( <br /> C BUILDINGapplicable): e S- (` oo CMS <br /> ASSOCIATED PERMIT# i(f <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> Fixtures List of Fixtures -#ores List of Fixtures F xture List of Fixtures Fr#of s List of Fixtures <br /> •NC—Air Handling nits Heat Pump Toilet Backflow Preventer(Inside : <br /> Forced Air Syste, s Unit Heater / :athtub Urinal <br /> vi Gas Piping <br /> Boiler avatory(Wash Basin) Drinking Fountain <br /> IWater Heater Refrigeration ower Floor Drain <br /> Gas Firepla. Wood Stove Ki hen Sink&Dispo--1 j rease Trap <br /> Gas Rang= Ducting Dis washer "oof Drains <br /> Clothes er Hookups Other: Clot,es Washer -dical Gas <br /> Range ood t/ Wate Heater Ot er: <br /> Exha -t Fan Sink(S-.ice =ar/Mop/etc.) Oth- • U �{ <br /> SPRINKLER/SUPPRESSION SYSTEM �� I� "" \ <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.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:.mply with the State Contractors Law 18.27 RCW and 29 .200A WAC. <br /> City of Everett Official Use Only <br /> V V t2 r IsPERMIT t La �i2- 02P\D� <br /> Owner/Aut nzed A.•nt Signatu e Date F✓ \(Revised 9/23/2016) <br /> y <br /> Y <br />