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PERMIT APPLICATION IIIIIII <br /> BUILDINGAII IECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink.On#y;Please), PROD T SITEi INFORMATION <br /> PROJECT SITE ADDRESS: /0015 icy-r" A y& (02— PROPERTY TAX#: ©i CP-I 1(e C O/0 200 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATIONu <br /> OWNER NAME: CU(LT (,t L L-1612.1 c Ca 6 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (0 02 5 1 '1'1'4 AVENUE S'6 4:r two • <br /> CITY Cl./&2.6,1"7- WASTATE n ZIP "[/�U D 2.0e <br /> OWNER PHONE: Li25 330 147Curr <br /> r,OWNER EMAIL: CU -.L1LLlt3a'l066eP,titi1LD.AiJSrCo"A <br /> CONTRACTOR NAME, Si.,u,pso ry 5 <br /> CONTRACTOR ADDRESS: STREET 5'1(5 Z-5 2-' ° S T N <br /> CITY AILL,It^'4TC'4 STATE W/{' ZIP qg2. <br /> CONTRACTOR PHONE: L12 5 317 I9 (g CONTRACTOR EMAIL: 5tMp$cTr.rSgederi rn cr /v/sfii. La?✓1 <br /> CONTRACTOR LICENSE#(REQUIRED): S(NIPS f's LS3i-Q(2V, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): rQ4 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L.12. - 3 7-7 i g l g <br /> 4A(2.W'$ S ta.pr.) CONTACT EMAIL: Si NI 'Svi15, rdeet I ail 6) vnsI1,CBM <br /> BUiLDI G`PEI MIT APPLtCATlON <br /> Existing Use of Building: art ce Si^R—5 Contract Price of Work:$ 2S', 0t20 <br /> Proposed Use of Building: OFFI C-G spAck. Heat Source: UlGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached 0 Duplex ❑Multi-Family-#of Units: $Commercial 0 Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair KT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: &AØ / CXt5Ttvfa t?Fric6. SPACE -Th' ACG© ,44 4-r6 2 M6-67-tjk l2vv."-tS <br /> AND Off <br /> ASSOCIATED BUILDING PERMIT# if a••licable: <br /> MECHANICAL PERMIT APPLICATION . ;PLUMBING;PERIVMIT APPLICATION �- <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration R it <br /> #of List of Fixtures #of List of Fixtur.: #of List of Fixtures #of ' of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pu •: Toilet Back Preventer(Inside Bldg <br /> Forced Air Systems Uni eater Bathtub al <br /> Gas Piping :.filer Lavatory(Wash Basin) Drinkin• 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 a Sink(Servic :ar/Mop/etc.) Other: <br /> SPRINKLER I 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 I 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 18.27 RCW and 296.200A WAC. <br /> / • City of Everett Official Use Only <br /> `l/5% /.8 PER ( ( OS <br /> lJ <br /> Owner/Authorized Agent Signature Date (Revised 9/2312016) <br /> 0/ <br />