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PERMIT APPLICI <br /> BUILDING f MECHANICAL I 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 i(E)everettepsieverettwa.gov i www.everethata.gov/perrnits <br /> (Blue or Black Ink Only Please) PROJECT SITE IHHFORMATION <br /> PROJECT SITE'ADDRESS: 12.l t , Let, t yvn, IDr, PROPERTY TAX#: <br /> LEGAL for new€onstruction: Short Platisubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 8 r I .ce. 5 tint ill TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sneer Pt) e 0 x 301_4GCrY �� SFA-re 1/08k, 21P �?-3 <br /> OWNER PHONE:° �t 03,54 OWNER EMAIL: c,-1,444:44‘—' Z)iesice,.Smt rit lei5Oaenham,4° ? <br /> CONTRACTOR NAME: k31.bli &)A/Ael1-71-e---417.0V6 <br /> CONTRACTOR ADDRESS: sir <br /> art 4- S V// s- -IE - /96X273 <br /> CONTRACTOR PRONE: 425. 513 f)123 CONTRACTOR EMAIL.: <br /> CONTRACTOR LICENSE#(REQUIRED); lclO/ 94 Et CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5" 4,6 61 <br /> PRIMARY CONTACT: °OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:: CONTACT PHONE: `i``.` „ " ' 6-0i+ 1)12.3 <br /> CONTACT EMAIL: <br /> BUnt.nING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ j,t1 01) <br /> Proposed Use of Building: Heat Source: OGas °Electric DOther <br /> Building Type: OSFR-Detached OSFR-Attached 0 Duplex OMulti-Family-#of Units: °Commercial Olndustrial <br /> Type of Project: ONew °Addition °Remodel 0 Repair _,DT.I. °Sign °Sprinkler °Demolition °Change of Use <br /> DE i - -tTION F WORK: 0, '- d ;r / LG�f' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL,PERMIT APPLICATION PLUMBING PERIBIT APPLICATION <br /> Type of Project: - New Atkin Aiteradon RepairType of Project New Addn Alteration .Repair <br /> Fixtures of Fixtures Fixtures List of Fixtures F.# List of Fixtures of xturesFixturesList of Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Prevennter(Inside Bldg) <br /> if Forced Air Systems Unit Heater Bathtub Urinal <br /> _Gas Piping Boiler Lavatory(Wash Basin)' Drinking Fountain <br /> t Water Heater 'Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> t Clothes Dryer HookupsOther: Clothes Washer Medical Gas <br /> Range Hood I Fs' ,1p .Water Heater Other: <br /> Exhaust Fan Sink,(Service/Bar/Mop/etc:1 Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water 1 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 /> currant federal,stale,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.I am the owner,ori am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contract. e:w 18.27 ROW and 298.200,4 WAC. <br /> City of Everett Official Use Only <br /> V,,,,911///: r,' • i - Of/7 PERI ; 1'l 0 -0l 5 <br /> Owner/Authorized Agent Signature pate (Revised 9/23/2018) <br />