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PERMIT APPLICATION= , <br /> BUILDINECHANICAL/ PLUMBING /SIGN /-11-I4tINKLER/DEMOLITION <br /> gn. <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)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITEINFORMATION <br /> R y <br /> Ph�4C 2S SIT D S , f �6Q-6614 107NY P,.39 OOOUQ-0007 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) A A CM t,I <br /> CONTACT INFORMATION.,, . <br /> OWNER NAME: . 00G TU1\)6•ik.-- TENANT NAME®(If Commercial): 6P �1� 1 N � � <br /> rb <br /> OVJIN MAILING ADDRESS: STREET 6 410 5V 5�cab-i� 7 AO1O 60bY <br /> WA*r : CITY V�i r-e U 1- STATE <br /> ,,kib ZIP 9'G C) <br /> OWNER PHONE: A-25- 252 ® 23 1 OWNER EMAIL: zjkQ ic [A 7&(Aci-Lt-- Co vvk <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> city STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> - CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 32KOTHER(Please Specify) A\- l Tc--ET- <br /> CONTACT <br /> C4CONTACT NAME: E,'yNtR,` --t„I,IC 1"1uuLe-ve_. CONTACT PHONE: 2 Co — 72 2._-- Zq II <br /> 617 N DeR jO R.D Av_c_i l-. CONTACT EMAIL: Ol,,DLO l JOCA-CVC_Vi .CO UVB, <br /> BUILDING PERMIT A,PPLICATI®N: <br /> Existing Use of Building: AJ O IsoDY ---PA( St1OP Contract Price of'Work:$_ 'D=ev 1 (0 00 <br /> Proposed Use of Building: ACU1-0 bvQ‘i iikEPAl... St$OF Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: -ECommercial ❑Industrial <br /> Type of Project ❑New ErAddition ❑Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: O t2-51/41 N 6 Ud I,0 1116 t 5e_t(IT "FOP- IN)0 iJ-P5124-1 I ITV) MA 1 T 101•) <br /> T-9---P‘451-1 N G Cot-tHaILaALb.DG... OCVA i 161,1)6. <br /> 6OMt. ADD(Tto .JkL (..,A13 0 sc- FI1,)• ). <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMITAPPLICATION PLUMBING'PERMT 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 /> 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: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/:SUPPRESSION SYSTEM <br /> JA 'Number 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 be.re bell, authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply wiit�he to Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 2/...5 <br /> •w �/Aut onzed Agent Signature ate (Revised 10/12/2015) a' <br />