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PERMIT APPLICAT- <br /> BUILC= /MECHANICAL/PLUMBING/SIGN /SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 j FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> �., �.� � "C�\� -�A�� ���. ��.��\^kms �.�,�v <br /> #� ,t>��$ k Ink4nly 1�lea�i); `�"> � S$TE INFORMATION �� ��� �L <br /> PROJECT SITE ADDRESS: (7( Ht.c.)' AVP PROPERTY TAX it: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INlroRMATloM <br /> OWNER NAME: TENANT NAME(If Commercial): R and kpr <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <-52,oea S-` <br /> CONTRACTOR ADDRESS: STREET /y/(7 6 1.47 / r A- <br /> CITY j�,pi(.wird / STATE (up.- ZIP ye°3 Ej <br /> CONTRACTOR PHONE: 4-24--771 J'I 7oce CONTRACTOR EMAIL: Amp cpeeo J d S n S_Cor , <br /> CONTRACTOR LICENSE#(REQUIRED) p�. �S CSS-�-Q CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER XCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: /� - ).7? — e)O92 <br /> J4meS ¶a y CONTACT EMAIL `1- - <br /> S `` C <br /> '`e' <br /> BUILDING_,P'EIT ?'_,4M�ATl, _ �.,�.. A�. ,ri �.s <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: OGas DElectric�,r °Other <br /> Building Type: DSFR-Detached OSFR-Attached ODuplex DMuiti-Fgmily-#of Units: yaCommercial ❑industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel °Repair OT.I. Sign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> Jn54-4t( G!wpiel I--e+ 9e aY► IZiCet„9a <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL,PERMIT APPLICATION...' ... ,' PLUMBIN PERMIT APPLIICATION <br /> Type of Project: New — Addn _Alteration Repair Type of Project: New _-,Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures 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 /> SPRIINKLER 1 SUPPRESSION <br /> 'Chemical or or Water 1 INo.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.1 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 /> –2— 5' —` 8 <br /> t02' <br /> \,v) <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) p <br /> r' <br /> k : <br />