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PERMIT APPLICATION <br /> BUILDING I IICHANICAL/PLUMBING/SIGN /UI4INKLER/DEMOLITION <br /> 111/11°:-/-7ACITY OF EVERETT PERMIT SERVICES <br /> l 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 1(E)everetteps@everettwa.gov� www.everettwa. ov/Permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: <br /> (co/ ifYta11 4PROPERTY TAX#: <br /> LEGAL for new construction: Short Piatisubdivision 44-a.© Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): 6PP.k4 U I Ilam <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 3 ,1 (Syl &Iv t ce:s <br /> CONTRACTOR ADDRESS: STREET 1(0,212 -e)p-}ip\t- e\feccek-1- . Fc-2-3c-1 <br /> CIN m i 4t Cup, STATE WA zip qw <br /> CONTRACTOR PHONE: 495 . gj(00 CONTRACTOR EMAIL: bb1s(gns C�rr sn.Corn )' <br /> CONTRACTOR LICENSE#(REQUIRED): ��TJ l gcropQ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):05 S I b4 <br /> PRIMARY CONTACT: O OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: -R-'Gy < CONTACT PHONE: 1as.330 .�ij th O <br /> CONTACT EMAIL: bh±S l g t S fr S f,Co� <br /> BUILDING PERMIT APPLICATION V <br /> Existing Use of Building: ('1 )-p h)ev,ja t Contract Price of Work:$ (P OO <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other_ <br /> Building Type: ❑SFR-Detached DSFR-Attached ❑Duplex OMuiti-Family-#of Units: 150mmercial ❑Industrial <br /> Type of Project: ['New OAddition ['Remodel El Repair OT.I. ErN,,n OSprinkler ODemolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> inAllk CI) LED larilf\ t 4\5pk1' ( <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 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 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/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT't 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.tam 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 /> _01113 /',, • PERMIT 05 J b 1 <br /> Owne • .rized Agen Signa re Date (Revised 10/12/2015) <br />