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FokkeifrtrA- <br /> #11111PPPERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.govfoermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> 0.q.2.Om coaog, • <br /> PROJECT SITE ADDRESS: 5/00 2.1lito 1-.1I--0,3C (AYES PROPERTY TAX#:Liteo zot, e41g$,I <br /> LEGAL for new construction: Short Plat/subdivision 56iirtAwf Odfat. Set" ItTri 7E (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 436034i.trt0e4C, Crtnetc110141 C44‘4444.4 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 9/0D 2,3 au ixt.t\If 4-tilE.Sr <br /> crry g STATE 14.,,hN., ZIP etC92.al <br /> OWNER PHONE: 4/zr 21n OWNER EMAIL: PI.44.r C oti oil...n.i,002,C3X/a/S774/u. 6 e a <br /> CONTRACTOR NAME tel(LirLia4— 6oclNlES <br /> CONTRACTOR ADDRESS: STREET /fizz, omtes prue ..5%.,..cre <br /> CIV? %) 14'11 STATE ZIP et 9 ZAI <br /> CONTRACTOR PHONE: q24-.....c,(yt —04 et) CONTRACTOR EMAIL: tZ12.A•rl1rt ft-taxt,e-t_(4:0-e . <br /> CONTRACTOR LICENSE#(REQUIRED): its el'Lki-451 SC. CITY OF EVERETT BUSINESS LICENSE#{REQUIRED): 0429 a <br /> PRIMARY CONTACT: 0 OWNER XCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: r.1.441"s, (7-444.1TZ. CONTACT PHONE: 4Zy- bq 04 I et, <br /> CONTACT EMAIL: iart4.4,n.. te.4.-or Lei — caPt <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 44%, Contract Price of Work:$ 23t, <br /> Proposed Use of Building: ,,ttee>1„... GLASS(to't't itArettitt.t4, Heat Source: OGas lectric 00ther <br /> Building Type: OSFR-Detached OSFR.-Attached ODuplex of Units: )arQommercial El Industrial <br /> Type of Project:IgtNew ElAddition EIRemodel ORepair DT.i. 0Sign OSprinkler ODemolition EIChange of Use <br /> DESCRIPTION OF WORK: w000vr,03 44 1;NI"441— Foe. -1 000 z sa- <br /> 4. CU t« 6.4t...DtprG. <br /> 4a, 2. — 001b <br /> ASSOCIATED BUILDING PERMIT#(if applicable): I - — — <br /> MECHANICAL PERMIT APPLICATION' PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn _Alteration Repair Type of Project: New Addo Alteration Repair <br /> #of #of #of #of <br /> List of Fixtures Fixtures Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> 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 /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER 1 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. 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 /> PERMIT# <br /> /,4 svi-7 <br /> OwnerfAutho'zed Agent Signature Date (Revised 9/23/2016) <br />