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� <br /> ,� BUILDING/MECHANICAL/PERPLMUITMAPINGPLI/CASIGN TIOf/SPRINKLER/ 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: toos pkwtt IVF-Sfi Ave PROPERTY TAX#:005,0001.01100 <br /> OOLO3tOn <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> __-. Lito CONTACT INFORMATION <br /> OWNER NAME: f(Z5 Loot %AMts L. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET low NE I vol S'( !� <br /> CITY SSW LANe STATE 1014_, ZIP /Van <br /> OWNER PHONE: tO(• MA. 161,0 OWNER EMAIL: bb e paw h/O%C E.. CAM <br /> CONTRACTOR NAME: TIM iluA.};A'S Gf xq 46YUCA-!O L.L C <br /> CONTRACTOR^ ADDRESS: STREET 55005Ss g }k Q L. A] <br /> ^ . /.� <br /> " .49t_y, v'i Il e. CITY , STATE�A ZIPv!g a <br /> CONTRACTOR PHONE: 261 -p2g( -1114.6 111 CONTRACTOR EMAIL: 1.1 UM j*Cl e.IW S '7UCJ;oil_a C = • .s <br /> �/fCONTRACTOR LICENSE#(REQUIRED): ti U!V}-i Cl.qg L CC( CITY OF EVERETT BUSINESS LICENSE#(REQUI-'D): e/tpa <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR X OTHER(Please Specify) I4.. £'Z tee - .41ygL ill <br /> CONTACT NAME: p1#1.4 se„or.4zio CONTACT PHONE: 100_Lot I u <br /> CONTACT EMAIL: ALC Xli sal.../DES, 60M <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: W.. OUIPaEX Contract Price of Work:$ 3S/000 <br /> Proposed Use of Building: 4.1r. OvP&.EX Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: mSFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition X,3Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: it vegeekOsv Not,,,.. sutocer VRAL. 44e44.4,444ssitt" r ijelvirt ,c, <br /> PM At4c444 f NvEtoPfc. R.t.PAlas :*t,P1 Act.. ®gMAGED S/41 AmtwcA ttP IplP4, <br /> JINV3A) , toot-Si two i ex-sjC O. pow;, DEMO 3 DWLuS t svillll.D Z N>EA4 DECKS. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn g 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 Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump 'Z► Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 10., Bathtub Urinal <br /> Gas Piping Boiler V 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 'jam Dishwasher Roof Drains <br /> j_ Clothes Dryer Hookups Other: L Clothes Washer Medical Gas <br /> Z, Range Hood Water Heater Other: <br /> 4 Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <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 /> /:' " tlf!l lI Al PEFUr do C (>oG '' co <br /> 3 <br /> /,....7„ <br /> Owne u' ori i Agent Sign ure Date (Revised 9/23/2016) <br />