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I II' PERMIT APPLICATION■ <br /> /111P.0104/ ;;:ii <br /> BUILDINGq MECHANICAL/PLUMBING/SIGN/SPRINKLER/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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2 3 20 Co_t i or n t 4 Stce of PROPERTY TAX#: 00 4' 8 b ,0000O0 <br /> LEGAL for new construction: Short Plattsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: S t1O ISO m t S CO�jr� i 1 D TENANT NAME(If Commercial): P U D <br /> OWNER MAILING ADDRESS: STREET 23 20Caacv C(Ivci Si reef <br /> CITY E Jeret tL STATE W AzipI 2.0 I <br /> OWNER PHONE:M dchGe I 1 CC le 11 c,,(1 425 83 ,84q5 OWNER EMAIL: rAd liana 0)Sud f o rr\ <br /> CONTRACTOR NAME: <br /> 010- SOUnl F1re prn+e("11nr1 Shc <br /> CONTRACTOR ADDRESS: STREET 2.0 20 Oc 4Ces A-V e SQD <br /> CITY E J e r e- i STATE w A • ZIP q 8201 <br /> CONTRACTOR PHONE: 425- 2 52 -00 65 CONTRACTOR EMAIL: all-1\0e 0)eNy,e1 oo c,re vro'cec}isr • OM <br /> CONTRACTOR LICENSE#(REQUIRED): C C P UFs S f 0 8 9 Fp CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):tV <br /> i;TE Lto <br /> QV' <br /> i <br /> PRIMARY CONTACT: C]OWNER CONTRACTOR O OTHER(Please Specify) <br /> CONTACT NAME: H MC�n Moe CONTACT PHONE: 42.5- z 52-0065 C tl, 415- 58 3-03 0'1 <br /> CONTACT EMAIL: a mee ?09 et-so 0 nafsl e 41,reke Cho, Co+, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: QI C C Contract Price of Work:$ 9'00 00 <br /> Proposed Use of Building: Heat Source: ©Gas El Electric DQther <br /> Building Type: ❑SFR-Detached IJSFR-Attached ❑Duplex ❑Multi-Family4 of Units: OCommercial IJIndustrial <br /> Type of Project: ❑New ❑Addition C]Remodel ORepair OT.1. ❑Sign XSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: I, t OCoke.. `2 5y r-,•k Ler s b ec c Q s e o C' p\o ceme^is • <br /> ASSOCIATED BUILDING PERMIT#(if applicable): R L1-2. - 032 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project New_ Addn Alteration Repair Type of Project: New Addn Alteration Repair <br /> #ofList of Fixtures of List of Fixtures List List of Fixtures of #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 /> SPRINKLER I SUPPRESSION SYSTEM <br /> Chemical or Water f O._ INo.of Heads <br /> ACKNOWLEDGEMENT.l have reviewed this application and confine the information contained herein is true and correct.Work done pursuant to this perm#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_tam the owner,or 1 am authorized by the owner of this properly 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 /> 7/6(re ) 1A s PERMIT#,A 9) © O 11 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />