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PERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING I SIGN/SPRINKLER/DEMOLITION <br /> tfil CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 i(E)everettaps@everettwa.gov i www.everettwa.govipermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMAT1ON <br /> PROJECT SITE ADDRESS: 1 t 0I FVereirein titap PROPERTY TAX#:Z VOS 070030010® ' <br /> LEGAL for new construction: Short Plat/subdivision 9 4 Lot No. (attach copy of long legal description) <br /> oap <br /> CONTACT'I <br /> //�� y�i ' NFORMATION y <br /> OWNER NAME: CSIIt i1»1tI°l CPiS(4iii f L�Gi 2Ct; 8-k L.Ci TENANT NAME(If Commercial): IVIAl f;/UAL tri t t NIA tea e S <br /> OWNER MAILING ADDRESS: STREET ?CI). jet]?, . 1 Gl ij 1p 1j} <br /> c+T'r ct,),1Jf°94 i!)'i , A -7C-2:'V STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 12E i'4 i) f(1c}11,1 °(tYlsirtic 1 iiix`l Si, rV it,t �',� <br /> CONTRACTOR ADDRESS: STREET %%Gt iC) Br eq-lar) tet,ef <br /> cf7Y W t( Rh`r t,er STATE �11 ZIP �_ci�5 Z-. <br /> CONTRACTOR.PHONE: s'. 3 ) , ' <br /> '� �'����5�� CONTRACTOR EMAIL: �b>'b�vl.�r� I� � t l i»l.Gif�tYltc� <br /> CONTRACTOR LICENSE#(REQUIRED): RE 1}q l(1.f, 4 S$ t)lit) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):TN,) {' <br /> PRIMARY CONTACT: D OWNER l CONTRACTOR Cl OTHER(Please Specify) 4;106:3 106 '-1.1 L-( 7 <br /> CONTACTftNAME: CONTACT PHONE it/rs.-Vii.,,(;)6-4,0 <br /> • <br /> +.J'i"an e n g e vi40Y) CONTACT EMAIL:Izonia t]v! e, t^t iG,:(1,s . isd),,ii <br /> BUILDING PE,RMIT,APPLICATION <br /> Existing Use of Building: y)j y z.el. Akt, f Contract Price of Work:$ 5th,(Lia <br /> Proposed Use of Building: 11 d C Heat Source: ❑Gas DElectric DOther <br /> Building Type: DSFR-Detached ©SFR-Attached DDuplex ElMulti-Family-#of Units: Litt-ernmercial Dindustrial <br /> Type of Project:,DNew DAddition; DRemodel Repair 'DT.I. CISign LOSprinkler DOemolition DChange of Use N. <br /> DESCRIPTION <br /> C IPT I GI OF WORK: i <br /> ,l <br /> w4)1,i??_l?'1i'�' rp������rsy�ait3 t re des � --- <br /> fit.e tr�,ra wait r >vntr �� t�?r�k �3 _ �>��'a `� j>�r i��-`� , � � �}�i <br /> qtr t ruler ,) p 't— wt, F 'k.sm-ne,t dz rn �. relict's iv4 fin .ev ,sere-p.t d n� — <br /> ASSOCIATED BUILDING PERMIT#(if applicable): .091/Pi/ � �I t I pier 11 - - .n 5 pate rl in S i7Lnil yrPi ii'l fejrl <br /> MECHANICAL PERMIT'APPLICATiON " ' PiuM1 $G PEu MI!r*ppLIGATII9N <br /> Type of Project: ^_New Addn _Alteration _Repair Type of Project: New Addn _Alteration Repair <br /> #of List of Fixtures #of .List of Fixtures #of List of Fixtures #.of List of Fixtures <br /> Fixtures ,L,-, Fixtures Fixtures Fixtures <br /> NC-Air Handling Unitst-eatPump Toilet Backflow Preventer(Inside Bldg) <br /> • <br /> Forced Air Systems ' Unit Heater Bathtub Urinal i' <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain , <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other. Clothes Washer Medical Gas <br /> Range Hood Water Heater Other. <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPR1N tR J s$URPRESSIONz"SUTEM', <br /> Chemical or Water l No.of Heads <br /> ACKNOWLEDGEMENT:/have reviewed thisapplicationend confine the information contained herein is true and correct.Work done pursuantto this permit must comply with <br /> currant federal,state,and local law.The granting of a permitonly authorizes approved work and no deviations therefrom Deviations must first be authorized ed in writing from:the l <br /> Building Official before being authorized under any circumstance.lam the owner,or l aria authorized by the owner of this properly to perform the work for which application is made, <br /> and!comply with the Siete Contractors Law 18,27 ROW and 296.200A WAC. <br /> City of Everett Official Lisa Only l <br /> PERMIT# <br /> is-- <br /> Owner thor d.Agent Signature Date (Revised 9/23/2016) 1 <br />