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IIII II II II PERMIT APPLICATION-II <br /> '1111,1* /—/--A <br /> BUILDINU ECHANICAL/ PLUMBING/SIGN RINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 l(E)everetteps@everettwa.gov l www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: i a o Q 31�' of SF PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 6.10)5 La- TENANT NAME(If Commercial): Al. ..( CCer 6cnq ,Qnc- <br /> OWNE/-Y G <br /> RMAILING ADDRESS: STREET Po —Ns( I a <br /> CAI-6A_ CITY v STATE IDA ZIP q8036` <br /> OWNER PHONE: gs 9'50- c?87 0- OWNER EMAIL: C e1Q115 h fr Sn.C.001 <br /> CONTRACTOR NAME: I\bei c(�(�Lr b(,r'j. ,DhC_ <br /> CONTRACTOR ADDRESS: STREET 1�'O &Y. 1%88 /� (y^/� <br /> i rr,���� CITY EOC STATE f+ ZIP q sat)(D <br /> CONTRACTOR PHONE: 5 5 a- a 87,P. CONTRACTOR EMAIL: u:-+ 1Cl.Lr b W9 C2).rns n.CO <br /> CONTRACTOR LICENSE#(REQUIRED): Pf e_1,k C5 7 /z..2, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 160t O q 5$ <br /> PRIMARY CONTACT: 0 OWNER X CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT- NAME: CONTACT PHONE: `- -�5 - 9$1a- <br /> T IOLC Xr-vi n CONTACT EMAIL: abet twf'b c. IY'5I"1_c.om <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: )Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition DRemodel ` epair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: /eralr /, , _�„ /Jn e.„ m 11/ <br /> 14./..0 , Le/Aid I e <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: New _Addn _Alteration _Repair <br /> #of #of List of Fixtures List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-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: Ali_I. <br /> _/ii, a Ai <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: , 17 Mira <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 /> 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT A-e-r)Cla rr-trreeei /4//',E( I —���;2C11 <br /> Owner/Authorized Agent Sign iure Date (Revised 9/23/2016) <br />