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PEl',r"ITi A.PLIC.TIC� <br /> BUILDING/ MEC, .NICAL I PLUM zINO /SIGN I SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> .4111/ <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Clack Ink Only Please) t•ROJECT SITE INPORMATIO- <br /> PROJECT SITE ADDRESS: '2 2_0 1 er3r W,xy PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision /Lot No. (attach copy of long legal description) <br /> .r� I CONTACT INFORMATION <br /> OWNER NAME: YJ `Ql one f' 1 WG TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 12 01 fi �h a..y S LA-6,4e C <br /> CITY T e -00 V / STATE 11,)A //�� ZIP -�Q3 <br /> yo <br /> -Ft PHONE: OWNER EMAIL: K/ EE1.�C O <br /> . t .c vv, <br /> CONTRACTOR NAME: A k x ,[1 1,/V), ( ?Yd c+A kvA._ e rl Ey,;(_. 4,C 't-CCI a l 1 <br /> CONTRACTOR ADDR :Lcr ,j�•1_ _O I 411 c.� IA '�7 <br /> CITY tg-43 &\< 1+e 6 STATE vJA- ZIP ?6;1. 1-75- <br /> CONTRACTOR PHONE: -O 6 +33 5 0 [ . CONTRACTOR EMAIL: So,►'�.2 <br /> CONTRACTOR LICENSE#(REQUIR O 3 `2_ - ITY VERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: C�OWNE CO TRACTOR L1 OTHER(Please Specify) r r MAhk e r <br /> p y) � � �y <br /> CONTACT NAME: Al K K t`vv\ CONTACT PHONE: p 6 335 0,8-3 <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: e+A,,1 Contract Price of� Work:$ 5 Do <br /> Proposed Use of Building: R e4- LrJ <br /> ` Heat Source: Gas DElectric CI Other <br /> Building Type: DSFR-Detached DS�FR-Att ched ❑Duplex @Multi-Family-#of Units: l.li mmercial ❑Industrial <br /> Type of Project: @New @Addition L7 Remodel @Repair DT.I. @Sign OSprinkler @Demolition @Change of Use <br /> DESCRIPTION OF WORK: .Va.,�Il�(•„D ® Y\ e) o S 1 —P o 14 L ] , <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 /> rj/ Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER 1 SUPPRESSION SYSTEM <br /> Chemical or Water Y No. 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 /> PEVA czz)(:::A. ....(To 3 <br /> _.... <br /> e i 7k._-, <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />