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PERMIT APPLICATION <br /> B G/MECHANICAL I PLUMBING/SIGN l Sf (LER/DEMOLITION <br /> 41010✓a CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (F)425-257-8810 I FAX 425-257-8857 1(E)everetteps©everettwa.gov j www.everettwa.gov/permits <br /> (Blue;or_Black Ink Only Please) PROJECT SITE INFORMATION <br /> t� <br /> PROJECT SITE ADDRESS: (3.0s-- / / S lv J ,(A)4. "3201 PROPERTY TAX#t <br /> LEGAL for new construction: ShortPlat/subdivision ., Lot No: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: /11 idat C© All TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS:. sTREeT.1305" //q't S 4-irc.e7# <br /> STATE rye. zie 70�aj <br /> OWNER PHONE: 412S 23' C3/0 OWNER EMAIL: <br /> CONTRACTOR NAME ft z,:5, Zisti.,/74 i47n <br /> CONTRACTOR ADDRESS: STREET /916/4 ,54„9,137-n 8lud, <br /> cdTr/114,75vrl7G STATE ti44- nP 1$''z 1/ <br /> CONTRACTOR PHONE: 360 (05-1 -71(7a CONTRACTOR EMAIL: 4-5en te%�-p(u L€ .M)f�ea 7,copy <br /> CONTRACTOR LICENSE#(REQUIRED): /Y i7227/1o(1.7 CITY OF EVERETT BUSINESS7UCENSE#(REQUIRED):., <br /> PRIMARY CONTACT: ❑OWNER Dit CONTRACTOR IJ OTHER(Please Specify) <br /> CONTACT NAME: G CONTACT PHONE: <br /> f(e%�h / 5.60los( 79aa <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION s, <br /> Existing Use of Building: Contract Price of Work <br /> Proposed Use of Building: Heat Source: "DGas OElectric DOther' <br /> Building Type: DSFR-Detached DSFR-Attached DDuplex DMuIti-Family+#of Units: OCommenial Olndustriai <br /> Type of Project DNew OAddition ORemodel ORepair OT.I. OSign OSprinkler DDemolition C1Changeof Use <br /> DESCRIPTION OF WORK: <br /> 5ra-S (o f 5e-f' <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 -,Addh Alteration Repair <br /> #of <br /> List of Fixtures Fres list of Fixtures List of Fixtures Fixtures of Fixtures <br /> FixturesNC—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 )f Other: Clothes Washer Medical Gas <br /> Range Hood S,45 Loq sit Water Heater Other, <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> (Number of Heads .' <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must Comply with'. . <br /> crurent federal,'state,and local law.The granting of permitonlyauthorizes approved work and no deviations therefrom.Deviations must first be authorized in waling from the <br /> Building Official before being authorized under any circumstance.Yam the owner,ort am authorized by the owner of this property to perform the work for which application is made; <br /> and!comply with the State Contractors Law 18.27 RCW and 2$&200A WAG" <br /> l l City of Everett-Of Ciel Use Only <br /> 71/2t1 (;PERMIT# <br />