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OP' PER IT a PPL8CAT0= <br /> BUILDING/ MECHANICAL I PLUM=-&NG /SIGN/SPRINKLER I DEMOLITION <br /> Noliwi CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 9820 <br /> (P)425-257-8810 I FAX 425-257-8857 j(E)everetteps@everettw..gov j www.everettwa.gov/permits <br /> (1-=loam or Black Ink *My Please) P OJI CCT SITE 11; FORMAT!! 13 I <br /> PROJECT SITE ADDRESS: fc 1 (t) s4L, ,e {y /A 14Y1 ROPERTY AX#: Z / 00 ACID 700 <br /> a <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy o nfi�l d cription) <br /> C#NTr4CT INFO I-MATIO`a <br /> OWNER NAME: Cnfr t k,A,;A ' ro v,, tual l(..,rail ,.A4EIlifft;W�E,,eiR nntecial): <br /> OWNER`MAILING ADDRESS: STREET �,6 L�[ /I( sa. ` .,,,, j VJ ct. J Zoo <br /> cS t-4 I.f 1.-e. CITY STATE vv A ZIP( , <br /> OWNER PHONE: 9°4„c-- set 1 C2 t bOWNER EMAIL: �C. 3®�,��iov,,c ?tom(A (,p, ki‘,1 „C5A✓✓✓”'Co <br /> CONTRACTOR NAM•E: I� C€5143f ii x. tc3vt 11(, A <br /> CONTRACTOR ADDRESS: STREET C4?0 �L "1 tLf, 14 SC"ct�c LJif ?,e796 <br /> CITY / STATE ZIP <br /> CONTRACTOR PHONE: <br /> So () dCONTRACTOR EMAIL: [s6 ce.inn ItiCita;t., ,IC ,„4-rc;d,, „,,,„, <br /> CONTRACTOR LICENSE#(REQUIRED): Q tilSa.L el I IP k CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5-64 ifYi <br /> PRIMARY CONTACT: 0 OWNER rA CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: (3 " 1 k ems- CONTACT PHONE: 3 ro y" 114 o <br /> CONTACT EMAIL cn, /J ~� / - ca <br /> - `fit CPca ` , <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ f0�66s. <br /> Proposed Use of Building: Heat Source: DGas DElectric DOther <br /> Building Type: DSFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: @New DAddition DRemodel DRepair DTI. ❑Sign @Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> h; S WJ t, r 0k ry 8 d 6�C\-ey-`o- W&t I <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 _Repair <br /> #of List of Fixtures #°{ List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures . Fixtures 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 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 /> j SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water 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 1 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/ RCW and 296.200A WAC. <br /> City of Everett Official Use <br /> Only <br /> `il /late. PERTfitsO1 ,dotbOed Age <br /> Date (Revised 9/23/2016) <br />