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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> Ev:P_ROJ,ECTSITE INFARif11AT1ON..,,.-. ' ? <br /> PROJEQSITf�DD SS: r ir,/ Mot PROPERTY TAX it: 05..31243a/-2_6036i <br /> LEGAL for new construct ort S at/sub.�issb Lot No. (attach copy of long legal description) <br /> EARESEMERREMESESESERENORtAl0t1SIKO#MAtitililandfininanNERNMEMENEE <br /> OWNER NAME: p ,� �'.... ,t,ft(A,is TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET .7061 00.... P.✓11 D l t c( ` <br /> CITY e/V ��_••••���1 _ �, STATE - zip ,j <br /> OWNER PHONE: 2,06 161 621 OWNER EMAIL: <br /> CONTRACTOR NAME: 140 M./(T().-4—?,(L-- <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE <br /> CONTRACTOR PHONE: CONTRACTOR EMAiL: �( <br /> CONTRACTOR LiCENSE*(REQUIRED): ��`` CITY OF EVERETT BUSINESS LICENSE#(REQUIRE ): FFF�����\ <br /> PRIMARY CONTACT: D OWNER 0 CONTRACTOR OTHER(Please Specify) 1,1 kLft-- <br /> CONTACT NAME: CONTACT PHONE: �2b0 653 -2,3 iS <br /> CAIt--014 to N • VP'VI 6.7CONTACT EMAIL: 19 D ktij q,`o� kr - ( ` mow„ <br /> INSISEESSEMESNMEnemotogarrosktitatitagoktUATIONIMEMEMMEMIngainfings <br /> Existing Use of Building: Contract Price of Work:$ 14Cat <br /> Proposed Use of Building: Heat Source: OGas ❑Electric ❑Other <br /> Building Type: Kiui/FR-Detach d ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project ❑New [Addition DRemodel DRepair DT.I. ❑Sign DSprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1 <br /> pc- /420 t 1ti1 t j4T - t 6L-t .a✓.4-cam <br /> $. /AT . A-L7 -rz <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> tail MECHANICAAL pERMITI,APPLICATIOIN r,,., ,:u „- ,:,`PLUMBINGaPERMiT 7APPLICAlltiNONMMOMitit <br /> Type of Project: _New_ Addn Alteration Repair Type of Project: _New Addn Alteration Repair <br /> *of List of Fixtures #of 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 /> f <br /> Forced Air Systems Unit Heater Bathtub Urinal i <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove i Kitchen Sink&Disposal Grease Trap i <br /> Gas Range Ducting Dishwasher Roof Drains 1 <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood(Co Water Heater Other: 1 <br /> Exhaust Fan t ink(Service/Bar/Mop/etc.) Other: 1 <br /> . .. SPRINICLERi/SUPPRESSION SYSTEMN_._.; / <br /> 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 before being authorized under any circumstance.lam 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. Jg <br /> City of Everett Official Use Only 4 <br /> -`---. .2/11 1 6 PERMIT# t,t a-oo l <br /> ,1 <br /> 1 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) i <br /> II h <br />