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PERMIT APPLICATION <br /> BUILDING I MECHANICAL/ PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> '110**11 <br /> -11 <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 1 www.everettwa.gov/permits <br /> PROJECtSITEINFORMATI®N ._ . <br /> PROJECT SITE ADDRESS:75/0 sa trim 16 r G Dr, PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> RENEMEMINIMEGEOMMEngraft;ffgOltifONWOONNENEEMENEENNESSERMIN <br /> OWNER NAME: fic/q 3'it a((,t tr Vt Q r- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 75/D t O(yl i c L7U"• q / q <br /> CITY fj tt Q eft- STATE Pe ZIP t 6L V3 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: p t�j b s (4/5"10–, <br /> V' <br /> CONTRACTOR ADDRESS: STREET 3/2 ( /.S 6t1475- <br /> CITY <br /> jCITY 5 Q t/'t STATE W iAr ZIP /g2-1 z <br /> CONTRACTOR PHONE: 4(25-2.(67 Q5 CONTRACTOR EMAiL: <br /> CONTRACTOR LICENSE#(REQUIRED):70 r'/G at) CtjJ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:� / CONTACT PHONE: t JC_-Z(Q '7O5 6/i�, S CONTACT EMAIL: '�D Cr R 5�!) <br /> { <br /> __ . d ._ag >f,__fz _ _ BUILDING,PERMiT_APPLICATION. :, g...:: �_ . ._..... .__, <br /> Existing Use of Building: F Q g. Contract Price of Work:$ 75C4 /lid— <br /> Proposed <br /> idProposed Use of Building: Heat Source: iaGas DElectric DOther <br /> Building Type: DSFR-Detached XSFR-Attached 0 Duplex ❑Multi-Family-#of Units: OCommerciai ❑Industrial <br /> Type of Project: DNew DAddition 181Remodel DRepair 01.1. DSign DSprinkler DDemolition DChange of Use <br /> f / <br /> DESCRIPTION OF WORK: -TO lit e to /<["te //t EUA ca/Yl n a is , Sl K k <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> _z MECH INTCAL PERNIJT APPLICATIONN,., .,_t , ,,. __.. PLUMBING;;PERMIT_APPL GATION _ _. <br /> j 1:. <br /> Type of Project: _New_ Addn Alteration Repair Type of Project: _New Addn Alteration ^,Repair <br /> #of #of #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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 /> 1 Gas Range t 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 /> #ry SP RINKLER1 SUPPRESSION,SYSTEM_na <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 FI <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 /> —.6. L PERMIT, / 193 <br /> /— <br /> av O^ _ ,r�,�2 <br /> Owner/Authorized ant Signature ! Date (Revised 10/12/2015) /v�J�v� <br />