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-4 `BUILDING ECHANICAL I PLUMBING I SIGN ciplINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIC = <br /> ' ' 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/pefmits <br /> (Bl a or Slack Ink Only Please) PR OJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: (Q at Ever en til 04 4 e Vcace „kat ft. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of tong legal description) <br /> COHTA T INFOI MATIONt <br /> OWNER NAME: j Q(St TENANT NAME(if Commercial): ' 0,0s-\- <br /> OWNER MAILING ADDRESS: STREET fitt--() G. ve_f'` vet"),r c..›...)0.1.1CITYw.vere. ii- STATE t,/..)tr- . ZiP <br /> OWNER PHONE: a 0(0- S, t 17 1 'OWNER/EMAIL: <br /> 1 <br /> CONTRACTOR NAME: oda ti�`P`t i S *M a c,. / C I.L,S 1-o yy CO 1 rk -y <br /> CONTRACTOR ADDRESS: STREET q '(o (,k) t ak do <br /> CPT (p <br /> Y ?0l'�- 1afr� STATE oR ZIP g a VI <br /> CONTRACTOR PHONE: 5 C)3�- a 61- 4 469 CONTRACTOR EMAIL: kocI.d cu skts m s c`i u <br /> CONTRACTOR LICENSE#(REQUIRED):T 0 00 el) 1 g 5-1 S N CiTY OF EVERETT BUSINESS LICENSE#(REQUI D):'See Rec. <br /> PRIMARY CONTACT: 0 OWNER ®CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: y, CONTACT PHONE: 5 03- y C ( -E 9(eco i <br /> -Todd 91 }i t k i Si CONTACT EMAIL: ase AS"�'OnfY S i91.) Thrr1Ct`t, C.i ill <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ i S() <br /> Proposed Use of Building: ( 1()%D r)P ?t>tOvl 'JAi& _Heat Source: OGas a -ctric pother <br /> Building Type: DSFR-Detached ©SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commerciai C)lndustrial <br /> Type of Project: ONew ®Addition ©Remodel 0Repair Ott. OSign 0Sprinkler ®Demolition OChange of Use <br /> DESCRIPTION OF WORK: <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 /> 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 i 5 Cr)v, Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER i SUPPRESSION SYSTEM <br /> Chemical or Water ( lNo .of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true end 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 Lew 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> \V\ 4 ' I 1 PERMIT# <br /> t��r-t`� S l�--c _ CD3 <br />