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PERMIT APPLICATION <br /> #.111Pd----g <br /> BUILDING / MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> .„44&7S1 CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECTSITE INFORMATION <br /> PROJECT SITE ADDRESS: I i 50 TyG�t e eat, v�0PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision ( Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: t ,, J /IV VCAS LLC TENANT NAME(If Commercial): Q4 0....0Ic_G2 <br /> OWNER MAILING ADDRESS: STREET /sn27 5tr $"U th S'f7Ll f T / '^ q ct�/�` <br /> CITY So7-TCI � STATE t�.1Ar ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Q.4. ►its (77/2._0‘,/ S / ID TZ s pAc... C—LC' <br /> CONTRACTOR ADDRESS: STREET So[S /1 S Th.. /7L siE <br /> CITY Fe2o (STATE LA../(A" ZIP q i <br /> CONTRACTOR PHONE: 4/2 S —4/9 "794(0 CONTRACTOR EMAIL: C(4v ( I2.C( 01 sak-E , a141 <br /> CONTRACTOR LICENSE#(REQUIRED):7B9. CITY OF EVERETT BUSINESS LICENSE#(REQUIRE.,. Phi-s • , V� <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify)._ l�' Y��i`sl.y/ i r . , Ili -W 1 <br /> CONTACT NAME: CM 0L (,2ex fEc CONTACT PHONE: Lfa s _L��• -- e ded <br /> �"� CONTACT EMAIL: &I els Eivii cp 'F , P 61 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: 4,; If <br /> o Zc <br /> Proposed Use of Building: Heat Source: ❑Gas El Electric ❑Ot,er <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Com. ercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair igz.l. ❑Sign ❑Sprinkler •.- oliti•. ❑Change of Use <br /> DESCRIPTION OF WORK: RE PiA43 Vi itei 1( t eii`T-LA" w11/4-1I toe. Ti741/41 a jjiifi v1 <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 _Alterati.• _Repair <br /> #of List of Fixtures #of List of Fi . es #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtur•- <br /> NC—Air Handling Units Hea - mp Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems .nit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash B. . Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen S., &Disposal Grease Trap <br /> Gas Range Ducting Dish er Roof Drains <br /> Clothes Drye 'ookups Other: C- es Washer Medical Gas <br /> Range H•••• ater Heater Other: <br /> Exha - Fan Sink(Service/Bar/Mop/etc.) Other: <br /> S' 'INKLER I SUPPRESSION SYSTEM <br /> Chemical or Water I 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 bef.re 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 wi/ "e State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of9-- k <br /> Everett Official Use Only <br /> r°..111.1.1" <br /> l/ /3 ( 7 PER I " O <br /> ( 4-- <br /> ,-.4,KtinturemActent,Signature Date (Revised 9/2312016) <br />