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oir.en. PERMIT APPLICATIO- <br /> 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 /> 1I PROJECT SITE INFORMATION <br /> PROJECT SITE i DRE S: Ve, ir,..„,,,,k,k. <br /> wik PROPERTY TAX#: 00‘+,5703770 vs 00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: SefFrtc1 k G41k.. 46v4/aY,G,, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (1' i' - beAviloyt kit, 0 <br /> re,.k\Y\4— CITY STATE WJ'"c ZIP ei a 1.-3: <br /> OWNER PHONE: 2,7(,' --3so - 6u#,+0 OWNER EMAIL: Coal;e(_ G, ayVIA I Ci0 114 <br /> CONTRACTOR NAME: OW 1 <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> . <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2,0(..0 %4 .-1Gi(a 4-0 <br /> ll.t $wAvA CONTACT EMAIL: CAtl .f...\.— C. I rU'T t‘ • C.O v <br /> BUILDING:PERN.....11T APPLICATION . <br /> Existing Use of Building: .;to j <br /> fidjt +- yvt �, r4 S l/ ,& \,(i ..• Contract Price of Work:$ 41-E'St 00°Proposed Use of Building: b �7 Y1'>,{j Heat Source: ❑Gas 'Electric DOther <br /> Building Type: OFR-Detached DSFR-Attached °Duplex ❑Multi-Family-#of Units: OCommercial El Industrial <br /> Type of Project: ONew "AdditionmodQQel `F; tepair DT.I. DSign DSprinkler ©Demolition DChange of Use <br /> DESCRIPTION OF WORK: dboJ SrT. (r((tpli�"to✓,t,'f'o n5e.., ,3,7..-, 5f eiiO4,„`"0 o 4,k-vov..61,11 405rAckA, ;oh .0- <br /> Go v <br /> GoI eco reRv• eWbvi j 104 r pm-i.0 alk' ioh , �r.epatY- -FVOVt. - to. c,)# I ye11a Ce., eX15•4(vt,. <br /> VOOT41 A6IA partAl 04AN 'rot) AAA--,cam ;{ii <br /> ASSOCIATED BUILDING PERMIT#(if applicable): VV <br /> MECHANICAL PERMIT APPLICATION' j . PLUMBING PERMIT:APPLiCATION. <br /> Type of Project: New V Addn Ks Alteration VRepair Type of Project: _New _Addn _Alteration Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Z- Toilet Backflow Preventer(inside Bldg) <br /> Forced Air Systems Unit Heater I Bathtub .. Urinal <br /> Gas Piping Boiler 2, Lavatory(Wash Basin) Drinking Fountain <br /> I Water Heater ' Refrigeration I Shower Floor Drain <br /> Gas Fireplace Wood Stove 1 Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting l Dishwasher I Roof Drains <br /> I Clothes Dryer Hookups Other: i Clothes Washer Medical Gas <br /> I Range Hood 1 Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> :SPRINKLER/SUPPRESSION SYSTEM': . <br /> Number 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 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 Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> tiara. \ _ V . 210 ' (0 VtI20Y0r // <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) (a.Ny-' _ <br />