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• <br /> PERMIT APPLICATIOI <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> 00,57.7 CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 f FAX 425-257-8857 f(E)everetteps@everettwa.gov I www.everettwa.govlpermits <br /> (Blue or Black Ink OnlyPlease) PROJECT SITE INFORMATION ``''qq <br /> PROJECT SITE ADDRESS: �1— \-10_0C� 8�� '�PROPERTY TAX#: ®®� <br /> 6 6150 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> •�+ CONTACT INFORMATION - • <br /> OWNER NAME: Cd l66 -r f 4 ?i 11 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET CID-33oI.s`d�/%LI, -t- -i lV Q <br /> CITY BV rt.1 ilk&`fD E� STATE G�/l ZIP 48 ZZ'� <br /> OWNER PHONE: 3160' 5 ✓94i OWNER EMAIL: .1kto ICU"S Cacfri e-A-1 <br /> CONTRACTOR NAME: C vCK.C7P-E6AJ 5T-4-17i 'EEE T 1"46TA-cr <br /> CONTRACTOR ADDRESS: STREET 2120 PAG1 isc()1r • <br /> CITY r'✓ueceuT STATE (4./_ ZIP {r gaZo/ <br /> CONTRACTOR PHONE: 4-15-#2.52..-3//1.4 CONTRACTOR EMAIL: /L'JAilit.-Q 9/14S10( . 4-0AI\ <br /> CONTRACTOR LICENSE#(REQUIRED): COQ2.6.55 o22,0 Z' CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (.16-2. SCS" <br /> PRIMARY CONTACT: 0 OWNER faCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 475_2-5-2 <br /> �t CONTACT EMAIL: i4//4-64. Vh124 . <br /> BUILDING PERMIT APPLICATION - . <br /> Existing Use of Building: Vier G I use l Contract Price of Work:$ 0 <br /> Proposed Use of Building: el 0 ( FGr Heat Source: ❑Gas XIElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: fi2ICommercial ❑Industrial <br /> Type of Project: ONew 0Addition ❑Remodel ®Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OFWORK: ,� t lI) VLA L ASS.tte (4014,-0,6 Wif awe-V-145 ,kte£ <br /> (/ Deo,_ g6/o/�vd� ;(� Pmt <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICALPERMIT*APPLICATION • PLUMBING PERMIT APPLICATION • <br /> Type of Project: _New_ Addn Alteration (Repair Type of Project: New Addn Alteration Repair <br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #°f 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 /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number 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.l 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 /> (\0m2o )- (21 7 i PERMI <br /> rr <br /> Q 2r/Authori��� <br /> z t'Agent Signature Date (Revised 5/20/2016) <br />