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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING /SIGN/SPRINKLER/DEMOLITION <br /> "IIP :i <br /> Imo' _ CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 ORIGINAL <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.evere a.gov/permits <br /> 'Iii" �°�'�i�di h; � �`^'" I!�i I,��`6�Dli`_'..-. t:�n'�^*I P tl��i&.'�in�� N .�- �a - �u,��p;� �(070400740V,— <br /> ra � px�a �w - i as r,,p ii iii I h� =-�'� �i -_ iz <br /> 1,�4i , "�01 11 ,9dl��1 u,4iie-Wi OtilO El(070ORMATI �$Fl ��11i0����ry , H iA91J�91� <br /> PROJECT SITE ADDRESS: '���Vat r� PROPERTY TAX#: ON Li�� /�j��61�-(�I J� 3 Z(/ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> u1ip VJti fiV d6 bili alii H " - ` 7 -00 0140 101 10 1 T10CO Wtl rxy, u3 <br /> . dfik , 4 <br /> OWNER NAME: ,`Y4 61(i <br /> �+ _ TENANT NAME(If Commercial): <br /> .....t.). <br /> OWNER MAILING ADDRESS: STREET 1 Imoi Kt( *IL- <br /> CITY <br /> �,{y,� STATE (AJJJ ZIP`�/S7) <br /> OWNER PHONE:za6—' 4 Oct OWNER EMAIL: VVVV <br /> � - Harr-� <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET 1 11 2.0 gt— to 4 I <br /> CITY 146/ i�//1/2.(p STATE /J�ZIIPP l,�P)O <br /> CONTRACTOR PHONE:��/�""� I3� 'CONTRACTOR EMAIL:��'� �Q �,1 1` ((ii" <br /> CONTRACTOR LICENSE#(REQUIRED): L P Fj' ITY OF EVERETT BUSINESS LICENSE`##(REQUIRE,1116 <br /> PRIMARY CONTACT: 0 OWNER 4I CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT E: / CONTACT PHONE:(jPh--7/I — I-30 <br /> / <br /> l IIk\et <br /> ONTACT EMAIL: ►12ii( /D_ l��//QIIGrZ�y � <br /> ,, N -<,BUtil I__ ING PERMIT -PPLiCATIO ,,,- i <br /> Existing Use of Building: Contract Price of Work:$_57, <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: I'- =-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: 'P. ew ❑Addition ❑Remodel ( tepair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 11ce_ a� CIC- en OA - <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATIO*f '11-or.1--- PLUMBING PERMIT:APPLICATION w tta <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 Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> I Forced Air Systems Unit Heater Bathtub Urinal <br /> ` Gas Piping Boiler r 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 /> 'i SP10NKLER I SUPPPRESeSIOpN SYSTEM} r" <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.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'comply with the State Contractors -w 18.27 RCW and 296.200A WAC. <br /> l City of Everett Official Use Only <br /> b <br /> / I 11S Pff(,R) ( , 10. . <br /> Own h A nt Si atur Date (Revised 10/12/2015) <br />