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ellPfr,"/-_ PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> rAIV <br /> - CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please)� PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 26//11 I(# S14k Si-SSic. /01 b PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Rkverside eltra.‘AefTENANT NAME(If Commercial): ewe r) Ne-two(1c_ <br /> OWNER MAILING ADDRESS: STREET 2gn(DJJ 1 �{ :ez+ <br /> CIN Q`P t STATE W� ZIP gszo <br /> OWNER PHONE: 2O(0 • 510 - 2 5L,)a JJJ OWNER EMAIL: <br /> CONTRACTOR NAME: CO2 J-kthI 'Inc', <br /> CONTRACTOR ADDRESS: STREET 202)2 I Cp77/ ,4vt /V r �( <br /> cITY '' (o STATE 1 WA ZIP cj 2Z3 <br /> CONTRACTOR PHONE: � `•/435• e� (Xf•2Z1CONTRACTOR EMAIL: ktfle •fay(o('CO2 h4i •\(1mG•Ca <br /> yea ^9 <br /> CONTRACTOR LICENSE#(REQUIRED): CoZyh i* I Z 2.m m CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):021-1,021-1,0/08� <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR POTHER(Please Specify) e/InGtn <br /> /- <br /> CONTACT NAME:Jit/ hitt MpThre CONTACT PHONE: 126. �, 58 <br /> CONTACT EMAIL: 5 reer re+Wv'r ci(GQQ grcsOul1 'COM <br /> BUILDING PERMIT APPLICATION n <br /> Existing Use of Building: C41�WN4e.rCic`a A Contract Price of Work:$ (o f D 0 <br /> a <br /> Proposed Use of Building: Heat Source: OGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: //vac.`,ne cha n i cal ,- 8 f' Xk. ceic'1 io <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 #of #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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 ' X Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hoodre i ispl- Water Heater Other: <br /> Exhaust Fan up (.u➢LF Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Chemical or Water I 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!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT <br /> #IY1 (1D ` w Z <br /> 9/iiii7 D B <br /> Owner/A h rized A en Sig ature Date (Revised 9/23/2016) <br /> (JZ <br /> Z, <br />