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PERMIT APPLICATION <br /> BUILDING =CHANICAL I PLUMBING/SIGN/ 1 WINKLER/DEMOLITION <br /> /11°//oti*:///';-----A <br /> vitill 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 i www.everettwa.gov/permits <br /> (Blue or Black Ink Only:Please) PROJECT SITE,INFORMATION <br /> PROJECT SITE ADDRESS: 7 1 02. 1_01,61,47 rf � � � � J � PROPERTY TAX#:Ob 2..-OCOI) 2_ <br /> LEGAL for new construction: Short PlattsubdMsion Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: SI � <br /> JJ Id-� 1...-1.--t,1...-1.--t,' TENANT NAME(If Commercial): <br /> _ <br /> OWNER MAILING DRESS: STREET ,e())( --71(i <br /> j�j �' � II� CITY II��.lif��,I.�'r STATE <br /> ZIP 4732_a4 �,®��,�,, <br /> OWNER PHONE: 12 • ii b'1 -Sl i OWNER EMAIL: D�gM AJ. h 4P,M(Lily �f h.1I Lm a t -all J <br /> CONTRACTOR NAME: yyi I <br /> CONTRACTOR ADDRESS. STREET p 0,p)5)( lap <br /> CITYwilei,4 STATE t4 ) ZIP 61 % (-la <br /> CONTRACTOR PHONE:q • ! 0-til CONTRACTOR EMAIL: (VILA,• hr 4 of e i.i _t t j / <br /> CONTRACTOR LICENSE#(REQUIRED) 1),91145 r(vim�� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: D OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: i'�. ��Q q�b <br /> {{f1) h CONTACT EMAIL: U I iac' /j (0 h U ,( <br /> ' - IdY) <br /> BUILDING PERMIT APPLICATIONOD <br /> " <br /> Existing Use of Building: Contract Price of)Work:$ 4%1 i 116e <br /> Proposed Use of Building: ROI) pDhS•init;4161, k 5(Y,FX fl4 feat Source: Elkas ❑Electric DOther <br /> Building Type: EIS7R-Detached DSFR-Attached 1161buplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: L/INew (Addition ❑Remodel ❑Repair DT.I. OSign OSprinkler ODemolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> MW eonc5-Vu e on/ r Dtkpkx lkiscLuttiulL <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ` <br /> MECHAIIcAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION" <br /> Type of Project: iNew Addn _Alteration _Repair Type of Project: New _Addn _Alteration _Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fi tures List of Fixtures Fixtures <br /> 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 p Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> 4' 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 V Water Heater Other: <br /> (.) Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER t 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.lam the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> and «.mply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 41y 1 L(A qJi Tri � 1-20 ?-oo� <br /> • . Authorized Agent Signature Date (Revised 9/23/2016) <br />