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110 PERMIT.AIPPUCATIO1 <br /> BUILD11NG I MECH kMCAL/ PLUM:,1NG /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> • i 3200 CEDAR STREET,EVERETT,WA 98201 <br /> Vl <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or 'Aleck Ink Only Please) l" OJECT SITE INFO M; TIO <br /> :,: <br /> - <br /> PROJECT SITE ADDRESS: t ja© C.OI 13 y av PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION _ <br /> OWNER NAME: 3 5��-5(at cpn.5-frucricyrs TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET '1 al n D 57 <br /> CITY MCA K r I"�' ,-© STATE CAPg ZIP 61t;75 <br /> OWNER PHONE: 42-5 -•ai f q-ci q`/ OWNER EMAIL: <br /> CONTRACTOR NAME: JCAZrj iarr-5'la Gon5rrO cr <br /> CONTRACTOR ADDRESS: STREET 3Q j g n D �'T Q <br /> CITY 1 n u k 1 I Tet STATE (�at ZIP p!7n <br /> `15 <br /> CONTRACTOR PHONE: q2-a-L,.94,-- c}a3 I CONTRACTOR.` REMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): 5Lti5 5TG Dg 7 jot L CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ikiOWNER t21 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Gla5-140-60—44(9. <br /> 1 ) 5-1-0 —e- . CONTACT EMAIL: J <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: yrre.) Contract Price of Work:$ i �I a <br /> Proposed Use of Building: f"p y- Sal-e - Heat Source: ❑Gas !r'- ectr DOther <br /> Building Type: jiiSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family of Units: ■Commerc'- ❑industrial <br /> Type of Project: ❑New DAddition DRemodel P:IRepair CIT.!. ❑Sign ❑Sprinkler DDemo lion ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> r•10 - - - - .�("Dry Gal I 1 1-e_474 Z C <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PE-MIT APPLICATION <br /> Type of Project: New_ Addn _Alteration it. Repair Type of Project: _New _Addn Alteration itRepair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #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 f Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration 3 Shower ) Floor Drain <br /> Gas Fireplace I 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 /> 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 <br /> of Everett Official Use Only <br /> e PECt ,2c.)( <br /> . ...)1/4......) <br /> ...cog_ <br /> Owner/Au orized Agent Signature Date (Revised 9/23/2016) <br />