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PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> d CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET.EVERETT,WA 98201 <br /> (P)425-.2.57-8810 FAX FAX 425-257-8857 I(E)everetteps@everettwa.gov i www.everettwa.gov/permits <br /> dills or Black ink Only Pled) PROJECT SITE INFORMATION <br /> 3ROJECT SITE ADDRESS: 3LIOZ tit :T"tal-) ME. 6:11e4611/ '.Z9) PROPERTY TAX# 315127-7.0 .1f610 <br /> _EGAL for new construction: Short Plat/subdFvisiori ..... .Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> )WNER NAME: M S i TENANT NAME(If Commercial). <br /> )WNER MAILING ADDRESS: STREET ( 1) e <br /> GIN .a: c'rhYE Zip f: <br /> )WNER PHONE: .11O` bI LID <br /> OWNER EMAIL: i ,ll t '`Q,f ►hi:.... <br /> .ONTRACTOR NAME Coel'VF,, ,cS7 ONF. �Qlla �. 1 NC• <br /> :ONTRACTOR ADDRESS: STREET /71,21 /5' cS' . 0/0/4 <br /> ....CITY 1� STATE WA- Z#t? �>' ` <br /> 446-41111 <br /> :ONTRACTOR PHONE:, ' + " "" tp, CONTRACTOR EI L: 10 iltvemetes7tre# 0°a' ,11t Corn <br /> :ONTRACTOR LICENSE#(REQUIRED; l tj,, ,C 7) -CITY OF EVERETT BUSINESS LICENSE y(REQUI D): 03atr <br /> 'MARY CONTACT: 0 OWNER riti<ONTRACTOR 0 OTHER{Please Specify) <br /> :ONTACT NAME: CONTACT PHONE 1./26---die?6"- -D//J <br /> tri : <br /> ��D -"titD JU : a# CONTACT EMAIL: <br /> xn� Use BUILDING PERMIT APPLICATION <br /> Contract Price of Wor .$ '` O <br /> of Buildirtsx 4 ��: '� <br /> 4ropc ed Use of B'tiding: Heat Source, ❑Ga. ❑Electric • her, <br /> Adinsi.T' PR-Detested ❑SFR-Attached ['Duplex ❑Multi-Fat(1ity+#of Unita; ❑Commercial. ❑Industrial <br /> it,:.of.Prs r ; ❑New ❑Addition ❑Remodel IR:".1T.` ❑T.i. ['Sion OS o•Inkier DDemolition 0. e" of Use <br /> )ESCRIPTION OF WORK f e. . <br /> yam, <br /> Kemne. Ma5f� I fo io�c 4 heRla-� w� /Uhi Cir s di o4_ <br /> kSSOCIATED BUILDING PERMIT# if:04 icable:.,.._ <br /> MECHANICAL PERMIT APPLICATION PLUMBING PRAT APPtICATION <br /> ype of Project _New _ Addn Alteration _Repair "' Type of Project _New _Addn Alteration _Repair <br /> Fixtures List of Fixtures List of Fixtures *°f List of Fixtures p°f List of Fixtures <br /> Fixtures FixturesFixtures <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 /> Exhaust Fan , <br /> Sink(Service/Bar/Mop/etc:) Other <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> rNut of Heads <br /> ......:..:... <br /> .CKNOWLEDGEMENT:•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 /> urrent 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 /> Wilding Official before being authorized under any circumstance,I am the owner.or I am authorized by the owner of this properly to perform the work for which application is made, <br /> nd I comply with the State Contractors Law 18.27 RCW and 296.2004 WAC, <br /> city of Everett Oficial Use Only <br /> o+ [PER *7 \' io \zo <br /> __ - <br /> iwtler Atithothied Agent Signature Date (Revised 6/202016) <br />