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PERMIT APPLICATION. <br /> Ir4/4k7—A 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Elm or Black Ink Only Please) . PROJECT SITE INFORMATION} — <br /> PROJECT SITE ADDRESS: ///O 8 �,A�q n w j/ c: ) JPERTY TAX#• <br /> LEGAL for new construction: Short Plat/subdivision ' � / Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (47-.rec. -oaf TENANT NAME(If Commercial): 4 f Qetxr,i..F SH.r <br /> OWNER MAILING ADDRESS: STREET " L)toy 97" }-, / 7 <br /> cnv t� ny)l„ID�ae.� / STATE kvii- ZIP ,707 <br /> OWNER PHONE: ,�4 -a4 171 OWNER EMAIL: Lf9S s f yNA?) .1 <br /> CONTRACTOR NAME: �j ,�e <br /> CONTRACTOR ADDRESS: STREET /29,C ' (4(� 7 4' A <br /> t <br /> cm, G� 414 1.)04.3 y <br /> STATE tiVar ziP yS07 <br /> CONTRACTOR PHONE: 4-23-)-73 0 07 CONTRACTOR EMAIL: i @„c (4A <br /> CONTRACTOR LICENSE#(REQUIRED):s :y..0S r `1 -S() CITY OF EVERETT BUSINESS LLCEN #(REQUIRED): CS-3q.2.0 <br /> PRIMARY CONTACT: 0 OWNER VdONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 42'--)73-0 <br /> t o_..3 CONTACT EMAIL: oftew ,g �� _6401 C, f; ^ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ /•75-Z <br /> Proposed Use of Building: Heat Source: OGas DElectric DOther <br /> Building Type: DSFR-Detached ❑SFR-Attached ODuplex 0Multi-Family-#of Units: OCommercial Dlndustrial <br /> Type of Project: ONew OAddition DRemodel DRepair OT.I. OSign OSprinkler ODemolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> S'or>ye•-f <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 #°f Ust of Fixtures #of Ust 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 Baler 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 I SUPPRESSION SYSTEM <br /> Chemical or Water INo.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 therethom.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. <br /> City of EverettveOfficial Use Only <br /> 1 PERMITpIJ�, c��1 J <br /> nature Date (Revised 9/2.16) <br />