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PERMIT APPLICATION <br /> OLTBUILDING/ MECHANICAL/PLUMBING / SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-237-8810 I FAX 42�5-255f I(L)everetteps ct everettwa.gov j www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: p� I Lit"" a sl. !PROPERTY TAX#:W-I ObtllJO e«L/ <br /> LEGAL for new construction: Short Plat/subdivision Lot No., (attach copy of tong legal description) <br /> CONTACT INFORMATION <br /> OWNER NAMETc (\ -7--OSSCI C TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREETS S (�(9C) L`"i " Pi, e (A <br /> CITY 6/eo �'�J: STATE (.7t,. ZIP`^� ' <br /> OWNER PHONE:L�� CJr <br /> - �(„{C. o !OWNER EMAIL: <br /> CONTRACTOR NAME: Wil-91/AJ6177)6J 4.-ja /-16-147-61Z-5 <br /> CONTRACTOR ADDRESS: STREET I'll y ��/�2�„ `a( fit- A-rt ' — P6 IDX 5724 g G <br /> CITY peril-64 <br /> r STATE (AO ZIP l /1 ) eS'' <br /> CONTRACTOR PHONE: 42.6- -- £g71 (CONTRACTOREMAIL: ()J/3-tattiVAC 06imn,4(Li Curr <br /> CONTRACTOR LICENSE#(REQUIRED); Wil- kV, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 3 <br /> PRIMARY CONTACT: I] OWNER COCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME• CONTACT PHONE: t.7� _S 3_ f'7/ACC I Da-4145 CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION /n <br /> Existing Use of Building: Vi Ci1r hoc, Contract Price of Work:$ ../d(�I�'— <br /> Proposed Use of Building: Heat Source: OGas ctric <br /> 0 Other `,N <br /> Building Type: 9R-Detached ❑SFR-Attached ODuplex ❑Multi-Family_#of Units: ❑Commercial ❑End trial /` <br /> , <br /> Type of Project: ONew ❑Addition ❑Remodel 0 Repair DT.I. ❑Sign ❑Sprinkler °Demolition °Change of Us; 18 L4' ---.. <br /> DESCRIP ON OF WORK: <br /> 04 il‘e- Cd---EIP/ila- I Eieci--v 1 t. Wil(144:61(-1/7S) <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 _Roper aQ(l <br /> e, <br /> M of List of Fixtures #of #of #of '�--'"YY�� <br /> Fixtures Fixtures List of Fixtures List of Fixtures List of Fixtur <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 t Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> ' SPRINKLER/SUPPRESSION SYSTEM <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 circumst /am the owner,or I em 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 1 . 7 f4C// •s,200A wAC. <br /> ,/ r <br /> z. <br /> i' CiLA1 q City of Everett Official Use Only <br /> f �" 3.(G �! �! <br /> FERMI # <br /> ner/Authorized Agent Signature Date ' Y 4 �6) '�� ' <br /> (Revisec!5/20f2016) <br />