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PERMIT APPLICATION <br /> BUILDING 1 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 30,03 t..1. Cas inns Rd E itrel-{ t W A t:k 203 PROPERTY TAX#: <br /> LEGAL for new construction Short Plat/subdivision V- V 7i..ot i o._ (attach copy of long legal description) <br /> TACT INFORMATION <br /> OWNER NAME: Otte i+n 4 TENANT NAME(if Commercial): c3oetik <br /> OWNER MAILING ADDRESS: STREET '-' 00-'5 t.3• C:r.s',n«) Ri4 10 Lc; a i rli) tAO'01 <br /> V-03 <br /> CITY ,�1 ekt SLATE LJA ZIP .• <br /> OWNER PHONE: tk25-'3olo- *,nej ! OWNER EMAIL: Mos e.,ret*, 1•, . 1 n&ina.rQ. € soe; , .cots* <br /> CONTRACTOR NAME: Oriiwtteit.Al tiNal:0.1440k( CD+,.•k -a.c400 , l AC• <br /> CONTRACTOR ADDRESS: STREET (((a 11 141 't"' 0tact 1,,.1I Sk <br /> CITY i./1 tt.1G t•-%-co STATE W Ila ZIP `i 21 S <br /> CONTRACTOR PHONE: 25; .-(010.1oka CONTRACTOR EMAIL: bltvti4c.i4di e DMC1 . Co 'w`^ <br /> • <br /> CONTRACTOR LICENSE#(REQUIRED):4k U1.1 I VMC ra 3943100i CITY OF EVERETT BUSINESS LICENSE#(REQUIREO): to 7 2C <br /> PRIMARY CONTACT: 0 OWNER iI4 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 25 (e'7 0- q O S 0 <br /> ''A . M'-k1v If CONTACT EMAIL: 'dare).. i.;\v174VAC',.co nom. <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: loo-kaa oa.•-„ Contract Price of Work: $ 10,OOO� <br /> Proposed Use of Building: ksa.-tn for-, ,re..w%o oil,t Heat Source I:Gas DElectric DOther <br /> Building Type: ❑SFR-Detached ©SFR-Attached El Duplex ©Multi-Family-#of Units: DCommercial IX/Industrial <br /> Type of Project: ONew DAddition ZRemodel DRepair ❑T.I. OSign EISprinkler ❑Demolition DChange of Use <br /> DESCRIPTION OF WORK: <br /> 2+wr 040 to of 10,....-1/41,,00,-. W ti- K.tJ,h ' ^ 54+V t S , <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 Adds Alteration X-Repair <br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtured Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump ToiletBackflow Preventer(Inside Bldg) <br /> Forced Air Systems ` Unit Heater Bathtub 3 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 RangeDucting 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/SUPPRESSION SYSTEM ___ <br /> 'Chemical or Water I JNo. 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 focal law. The granting of a permit only authorizes approved work end no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.i am the owner,or I am authorized by the owner of this property to perfomm the work for which application is made, <br /> and!comply with the State Contractors Law 18,27 ROW and 296 200A WAC. <br /> City of Everett Official Use Only <br /> ---e„..--:„ io, , , , , , <br /> 1 QI <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />