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Jan 28 2019 11:50AM Washington W.-Ieaters 8663757454 pac <br /> PERMIT APPLICATION <br /> BUILDING/ MECHANICAL I PLUMBING /SIGN/SPRINKLER I DEMOLITION <br /> #11111S--"" <br /> - CITY OF EVERETT PERMIT SERVICES <br /> Noir3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwe.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION ��// <br /> PROJECT SITE ADDRESS: 115 IfuJ I//"C_1 'PROPERTY TAX#:, J� ciVOO,'Oj3(oO <br /> LEGAL for new construction: Short Plat/subdivision <br /> Lot No._ (attach copy of tong legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 6L /e Ie,) Co /2I /s <br /> TENANT NAME(tf Commorcial): •—•"." <br /> OWNER MAILING ADDRESS; STREET (42 4 5 iii , <br /> my C-,./44,44 tt srroa GIA zP 9g70 <br /> OWNER PHONE: (OWNER EMAIL: <br /> • <br /> CONTRACTOR NAME: W/4514[I J6j'l fcJ Q I-- I H 5 <br /> CONTRACTOR ADDRESS: STREET 1-11 )2- I I(l A-4f t ` — Po foX SW...b 0 /y r' <br /> CITY �? Ula STATE iiiJC Y{l G ' <br /> CONTRACTOR PHONE: 422,6— -� C`1'7/ I ZIP r7 VfrlO <br /> ICON EMAIL: ��-���,f�.0 061M/911..4 OW <br /> CONTRACTOR LICENSE#(REQUIRED): riff' iI )e-- y(6' CITY OF EVERETT BUSINESS LICENSE#{REQUIRED): 3 1 <br /> PRIMARY CONTACT: 0 OWNER i CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACTffNAME' � CONTACT PHONE: Cll2, .-1 3_q�7/ <br /> " "'(1 DJi I-Cp I s CONTACT EMAIL: (,(1 <br /> fhvfttfi,;$41-C.@ 6474-iL,(G141 <br /> BUIL■ '• 0 PERMIT APPLICATION <br /> Existin• Use of Buildine: 1) ' 2,t C Contract Price of Work:$ <br /> Proposed Use of B ing: Heat Source: Gas tric Other <br /> Building Type:\ ❑ No h ❑ <br /> Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial Cl Industrial <br /> Type of Project ❑New ❑Addition El Remodel ❑Repair ❑T.I. ❑Sign I:Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIP ON OF WORK: <br /> a • <br /> 0/401 - P1461- 1 Eieckot W491?-/4-11t14645,7S) <br /> ASSOCIATED BUILDING PERMIT#(If applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New_ Addn Alteration Repair Type of Project: New Addn Alteration Repa r opt <br /> tiC,1). <br /> 0 of List of Fixtures #of #of #of i r. <br /> Fixtures Fixtures Fixtures of Fixtures List of Fixtures List of Fixtur <br /> Fixtures Fixtures <br /> NC-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 <br /> Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Coe Flange Ductiuy Dlsiiwasner Roof Drains • <br /> -•• <br /> washer Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood f Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other; <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> 'Number of Heads <br /> ACXNOWLEDGEMEIVf: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 uthorizes approved work and no deviations therefrom,Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any akorrnatan 'am the owner,or I am authorized by the owner of this property to perform the work for which episrioatton la made, <br /> end I comply wilh the Siete Contractors Law 75.Z7 ROW and 7.B 2004(NAC. <br /> ( L(1ZPER CO of Everett Official Use Only <br /> LU/ Q,` ` z .1ict tq o ' <br /> 0 ler/Authorized Agent Signature I <br /> Date (Revised 5/20/2016) <br />