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016-77- PERMIT APPLICATION <br /> BUILDIF MECHANICAL/ PLUMBING / SIGN / _. RINKLER I DEMOLITION <br /> CITY 01=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! www.everettwa.gov/permits <br /> (Blue or;Blac l k,Only Please) PROJECT SITE INFORMATION • ' <br /> PROJECT SITE ADDRESS: ZQ 3 DLI VE,571:2,5E.7" PROPERTY TAX it: 005962,00 e 0(0 I <br /> LEGAL for new construction: Short Plat/subdivis ion Lot No. (attach copy of long legal description) <br /> CONTACT' INFORMATION <br /> OWNER NAME: FLEC145I61-EIN) L.-.A.R .y TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 12D'3 ©LIVES .-t- <br /> CITY ,EVE12.Eri- STATE WR ZIP 9800 3 <br /> OWNER PHONE: S ,0 -9.0 7 4,it 4,t3 OWNER EMAIL: <br /> CONTRACTOR NAME: OL'(rY)P/G lk-IE II}N)G4L ZfvC, <br /> CONTRACTOR ADDRESS: STREET V7(8 (,)(011-11- <br /> )(01' - A,AlE, W 27 <br /> , * 0 <br /> CITY M,0 U rytTL.i"c -a7 FR - STATE\4 J pt , ZIP 984 Li 3 <br /> CONTRACTOR PHONE: L[2-5-7714-88C-t'' CCNTRACTOR EMAIL: /j+ege @ 0, /mp.(Crne,e.hcN'kCdi1 Corn <br /> CONTRACTOR LICENSE#(REQUIRED): OLYMPN(Lt1 O 01 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0/ 92(00 <br /> PRIMARY CONTACT: 0 OWNER YCONTRACTOR 0 OTHE.R(Please Specify) <br /> CONTACT NAME: CCNTACT PHONE: L}25-ri 7 L-4-see-( ) <br /> T`EJ� E Z._, CONTACT EMAIL: plYyyl��C4'rie°C.9;iC�Y'.1, , CAS <br /> 'BU,ILDING PERMIT"APPLICATION w ' ' i,k m ',' , ` . ems. .__.. <br /> Existing Use of Building: Contract Price of Work:$ S9'to <br /> irst <br /> Proposed Use of Building: Heat Source: Gas 0 Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew DAddition ❑Remodel DRepair ❑--.I. ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> L_\ I ti �-�NipGP6FU c-><,' �-1 .8% TO 9�,% c tcl F--� Y7 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ,,&;;MECHANICAL PERMIT APPLICATION _ 4a, 'J:UMBING'PERMIT APPLICATION' ' , <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: New _Addn _Alteration _Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures 1 of List of Fixtures #of List of Fixtures <br /> 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 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 /> GAS FuRNAC- <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I No.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 I am 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 /> _.- <br /> 76� a �J i}-2 - M vol (51 -00 7 <br /> er/ <br /> Ow thorized Agent Signature Date (Revised 9/23/2016) <br />