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I I I I girPERMIT APPLICATION-nil
<br /> BUILDIECHANICAL/ PLUMBING /SIGNPRINKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION/
<br /> PROJECT SITE ADDRESS: 2,2 C0 o I p1 L._ g(o,, iw -1l�- PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: ,CPyteji s.tncl 0T-1-1,1
<br /> Y IZTENANT NAME(If Commercial): a U�,. c C ; �v ,aqil
<br /> OWNER MAILING ADDRESS: STREET 22.0 0 f jr{)P'j ( g/J,,k
<br /> CITY CtJ 11- STATE (A)p_ zipj g 2_03
<br /> OWNER PHONE: 47. 2.6 Q - so Z OWNER EMAIL: Clot 9 c,-4.h-zr) .cY r r);v sc,t 9•ma l j b 10
<br /> CONTRACTOR NAME:<O h p q[.cj rI,A 4 , ^R ,1u.1-,,,,,,....._
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): t A pr>%Lc4se..)
<br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: LA 2-S S.,71 r 14 1
<br /> G1 - 'f F+v't c„,-- V c,,,ct ) CONTACT EMAIL:6-1ai a h y�`•5.,,,_;..r,l V!-t�Q f,n 0.1,n,..).„,,,,, ,60,_
<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: Con,,h.-srf ,,rte\ h,i l'...(ati1 Contract Price of Work:$ 7 ;n p tj
<br /> Proposed Use of Building: C hws-c,• c..H, IA.`k-c>(,.,¢-,‘ Heat Source: ❑Gas 0 Electric 00 her
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Units: tfdGommercial ❑Industrial
<br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair EI.T17— ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> p (akr-,--7 act SA,-, • Rl�,,,_ rld00 f ka 1N: ar\ Food.
<br /> Toe. 201-11,e ( I Foods LLC.
<br /> ASSOCIATEI3'BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Type of Project: New Addn Alteration _Repair Type of Project: _New tdn _Alteration _Repair'
<br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #°f List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> NC-Air Handling Units Heat Pump ,O Toilet t? Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater (7 Bathtub d Urinal
<br /> 3- Gas Piping Boiler p Lavatory(Wash Basin) (l Drinking Fountain
<br /> Water Heater (tor Refrigeration Co Shower 0 Floor Drain
<br /> Gas Fireplace Wood Stove 1 Kitchen Sink&Disposal,/ Grease Trap
<br /> Gas Range Ducting ) Dishwasher tii Roof Drains
<br /> Clothes Dryer Hookups Other: Q Clothes Washer Medical Gas
<br /> Range Hood rO Water Heater f) Other:
<br /> Exhaust Fan K) Sink(Service/Bar/Mop/etc.)/ (? Other:
<br /> SPRINKLER I;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 properly 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 /> ity of Everett Official Use Only
<br /> PERMIT# / r-0,_,,..--Ark- -
<br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) . o 4✓DD I
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