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. <br /> PERMIT APPLICATION <br /> BUILDING 1 MECHANICAL 1 PLUMBING I SIGN I SPRINKLER/D.EIVIOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200:CEDAR STREET,EVERETT,WA 98201 <br /> _- (P)42 s 4ST:48810 I FAX 425457-8857 I(E)everetteps@everettwa.gov I wvrw:everettwa.gtrulperrnit; <br /> (Blue ort'Black intik Only Please) ROJEGT SIrTE,1$F DRMATIONI ;..r <br /> PROJECT SITE ADDRESS: coB vJ Co•1,+ho t'"? est.4f1.•4,0A ctszo14 Ibt�OPE ©#: <br /> LEGAL for new construction: ShortPlatttteubdivision _lot No. (attach copy of long legal tlesotjption) <br /> 'CONTACT INFORMATION <br /> OWNER NAME; C e;e.9 TENANT NAme(If Commercial): pec i.'.l <br /> OWNER:MAILING ADDRESS: arassr 2a001a . Co.5`a evo, <br /> cirr4.0. 1 ; STATE wJ A .xr.P '"§i a'7' <br /> OWNER PHONE: OWNER EMAIL <br /> CONTRACTOR NAME: 1If1,`.JtYS;iA.1 t`ttcL.:,h;ce4t•, Co,n-1Ya.c.}oeg 1 Ac. <br /> CONTRACTOR ADDRESS: sTt i r 11 44:01 •4 +t. Pt rata' W .5A <br /> errr I.Av.k+1 As a STATE tij fa Zr. 9 Pi 2.'7 5 <br /> CONTRACTOR PHONE: :5 3- to to,-q t4.9° .CONTRACTOR EMAIL:_ 10[,..'+A'cA+e S i.. a U c I . c,6* ^ <br /> CONTRACTOR LICENSE#(REQUIRED): kJ$ ISA C `143,-!-4:1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED ! a / <br /> PRIMARY CONTACT: D •WNER CONTRACTOR I *THER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2 53 - (o,10 - 9 ti Sr <br /> Sr i ev.% i 4rc Y4t kA CONTACT EMAIL: {ty i- 4 i.,411 Ai A..)MC s c.o r+� <br /> BU ,DIN iPERMIT APPLICATIIr}N <br /> Existing Use.of Building: Contract Price of Work:$ �7� v <br /> lather <br /> Proposed Use of Building:. .... Heat Source. -� <br /> as lectrie �£ <br /> Building Type, ti-iFR-Detached t .FR-Attached lauplex nulti-Family-#of Units: 'iiF-,ommerciai E1ndustrial <br /> �s <br /> Type.of Project: 'Blew: tddition aniOdel t 'epair .it .I. 1igf �.prinkler Iemoiition IhangeofUse <br /> DESCRIPTION OF WORK: <br /> • getlitze:t: co-Yri,Vei.r * ' 1.4 tAo-3c .`t'. f.,15 r <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> I MECHANICAL PERMIT APPLICA'll'ON r ::N, ; PLUMBING PERMIT 1PpLIC41#.0. 1 ..1: <br /> Type of Project: _New— Addn _Alteration Repair Type of Project: New Addn , ,Alteration _Repair <br /> • #of #of #of':: ft of <br /> Lit of Fixtures List of fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fi res 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: GreasO Trafs <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hoed: .Water Heater Other: <br /> Exhaust Fan- Sink(Service/I3ar/Mop/etc.) Other, <br /> SPitINKLER/SUP"P.RESSIUN�SYSTEM:: . <br /> Chemical or Water JNo.of Heads <br /> ACKNOWLEDGEMENT•I have reviewed this application and confintr 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.I am the owner,or I am authorized by the Owner of this property to perform the work for Which application is made, <br /> and)comply With the State:Contractors Law 18.27 RCW and 296:200A WAC. <br /> City.of Everett Oficial Use Only <br /> –___ PER ( Q Q �� <br /> DystneriAuthorized Agent Signature Date (Revised 12312016) <br />