2916 STATE ST GREEN NETWORK 2018-06-27

PERMIT APPLICATION #.911BUILDIN L ) MECHANICAL/ PLUMBING I SIGN /SPRINKLER/ DEMOLITION / ~ CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (BI44' Black Ink_4Inly I'I ase) I ROJEECT SITE I$FOItMATION PROJECT SITE ADDRESS: 291(, Sl-ale c-Cfree-1 Su!ft /o113 PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION. OWNER NAME: R I Ver6 JCte &mi et TENANT NAME(If Commercial): &teen I\/et-work OWNER MAILING ADDRESS: STREET 21 I (5164-k.,.S.4% .4 100 CITY EA/.eSTATE 1A1A, ZIP q$2,o l OWNER PHONE: 2O 510- 25Lig OWNER EMAIL: T(;f('k rWes-Cons-lructi OAY1 CONTRACTOR NAME: MOdliSU1 I(e MAYYlbinOiI?'1G CONTRACTOR ADDRESS: STREET 13318* &ht4s IZ}e, 53 0 N CITY 4r/if-It-cry) STATE wA ZIP gg22,,3 CONTRACTOR PHONE: 3(o -L135-555' CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED):P4 ..1S'L 10 0'E CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):02,5413 PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ROTHER(Please Specify) 7-errtr't- CONTACT NAME:S11 La NIG CONTACT PHONE: y25 3qt„ . (01458 CONTACT EMAIL: BUIILDINGPERMIT APPLICATION Existing Use of Building: Contract Price of Work:$ 1200 Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition El Remodel ❑Repair ❑T.I. CI Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: //slat/ btkit•er /1, a4 (Ina uM I i sink./ ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL'PERMIT APPLICATION`: ;• -, ; PLUMBING PERMIT APPLIfCATIO lL, Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair #of List of Fixtures #of List of Fixtures #°f List of Fixtures #°f List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood / Water Heater Other: Exhaust Fan / Sink(Service/Bar/Mop/etc.) Other: ,SPRINKLER;I SUPPRESSION SYSTEM Chemical or Water I No.of Heads 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 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 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, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only 41. 3/3117 M ` S 0° `A Owner/Au orized Agent Signature Date (Revised 9/23/2016)