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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING 1 SIGN I SPRINKLER/DEMOLITION <br /> 477 <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 /> ,...{ PROJECT SITE:JNFORMATI,ON <br /> PROJECTi 412 E0AgS' /* ArL av - �e L'''A <br /> g j.2 G°1 PROPERTY TAX#: ;If el"'-1;21-G b 1'37 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> a _ , _ _ : .CONTACT2INFORMATION:` <br /> OWNER NAME: 14 I/ t n v*34—„hcerk..3 TENANT NAME(If Commercial): 174.7/ 4-01' 6e 1-t-C. <br /> OWNER MAILING ADDRESS: STREET 134 CI/ 0 `J Ok co-t' k,". ^f <br /> CRY "eta. /41 <br /> 1/LI, i r-,0 STATE A l ZIP I°X45 <br /> OWNER PHONE: ZCJ b O`�s , q i 0 OWNER EMAIL: ( 11eu/1 X CiaX &31. ,1,Gr'�► <br /> CONTRACTOR NAME: C.�/V1 1aT"1tpep <br /> ('ra✓tut ') <br /> CONTRACTOR ADDRESS: STREET rCteici ( i/ e <br /> r-ITY E ,4-v�_ /� �a <br /> c /414+k STATE tj" zip -/ e13 <br /> CONTRACTOR PHONE: AOC_ qiff, 33C0-1 CONTRACTOR EMAIL: j,6 e `-"yjie-,3 tud-"las,x--, <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LiCENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR MOTHER(Please Specify) 0& itrep LLG <br /> CONTACT NAME: C..estivt 1-0—Are p ow CONTACT PHONE: 6 '1 i I. 3 i/e2.`�' <br /> � <br /> CONTACT EMAIL: ;orcer f" 1-35.9 L5 b:J14j� <br /> t. tiLyli'`'- <br /> itaitatialastaVAZIafgemat: ittIVAMIEWILDiNGMERMirAPPOCOPREgignAgNM-laliettiVPITAIMIA6 <br /> Existing Use of Building: 04:e.Vyr.• Contract Price of Work:$ 100, <br /> Proposed Use of Building: l�Q I'rc...si ti Heat Source: BGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: SCommerciai ❑Industrial <br /> Type of Project: CI New ❑Addition CI Remodel CI Repair ❑T.I. ❑Sign OSprinkler taDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: Qd✓t„,e,ve, t;,✓J1 s o,-E- ' `e_5 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> w MECHANICAL 1*RMiT APPLICATION ,., PLUMBING'.PERMIT APPLICATION v <br /> Type of Project: New_ Addn Alteration Repair Type of Project: New Addn Alteration _Repair f <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures # <br /> of <br /> Fixtures Fixtures Fixtures List of Fixtures <br /> Fixtures i <br /> A/C—Air Handling Units Heat Pump ToiletBackflow 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 I <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap 1 <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> 11 <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> 1 <br /> ,SPRINKLER`I SUPPRESSION SYSTEM _, <br /> Number of Heads i <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 t 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 Everett Official Use Only <br /> �/'___s>• 9_q-x U)7 PERMIT# <br /> D l' 1 nP3- OA <br /> Owner/Authoriz=•Agent Signature Date (Revised 10/12/2015) <br />