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BUILDING / MECHANICAL I PLUMBING I SIGN/SPRINKLER/ DEMOLITION <br /> ' <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 J www.everettwa.gov/permits <br /> •(Mane or Black Ink Only Please) PROJECT SITE I N FORMATION <br /> PROJECT SITE ADDRESS: _ COioliu ,eyia,` kue Li ii 11 A PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision pure VNJ g c4 O IJ i',. Lot No. Ibil-t4attach copy of long legal description) <br /> CiftNTP CT INFORM ATII N <br /> OWNER NAME: `: cx.I(AY9n (A,.\..e q py i Li_( TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 4 O(a s•-, ,I3 \3Zin - 2 <br /> CITY Kl r k (c.,9na STATE L) ZIP 111 d <br /> OWNER PHONE: 266-6h G - 6 2 i 7 OWNER EMAIL: AGO(0.-4"yv‘Gyl'a 031^vAa t I _ e--014 <br /> • <br /> aw <br /> CONTRACTOR NAME: Ce (�LJf V1,_ � k'"is o Cl'_�2Y10-i3 _4cxv1Ca uc-4 <br /> CONTRACTOR ADDRESS: STREET 1 OGS-S- (\2 1 v\A-. PI <br /> CITY i f k e Y a_ STATE Lt.)Vk ZIP l go <br /> CONTRACTOR PHONE: Zc 2 >-‘,4,41 -(d 2 i ? CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT:NgrOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: �, CONTACT PHONE: Z._-4,6,41_ 62 i '? <br /> i <br /> I coC-oAAC VY1- `_ e:I-al/cepa-I CONTACT EMAIL: ALL) �-f- <br /> t1�0.9/1 Q iMi la, . �0i--. <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: r 0 0 (-)(Q--,t Contract Price of Work:$ ZCZ e 0 0 <br /> Proposed Use of Building: • Heat Source: ❑Gas lectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ' uplex ❑Multi-Family-#of Units: Z @Commercial El Industrial <br /> Type of Project: ❑New DAddition gemodel ❑Repair ❑T.I. ❑Sign El Sprinkler ❑Demolition El Change of Use <br /> DESCRIPTION OF WORK: <br /> - oda , c-CANNt 5....'-YOM V'A \'V O-V2i ' OC... 2v4- Z cYN,415(4 ea)C 1 on 5A-4Z_ <br /> 72es-fafc Cc.k. o 4 -IT S ',viz Pa-„u...`/y <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 #of List of Fixtures #°f List of Fixtures #of List of Fixtures <br /> Fixtures . Fixtures • Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet et.O,Le Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> + Gas Piping Boiler Lavatory(Wash Basin)1 Drinking Fountain <br /> 7 Water Heater g/,a �wf Refrigeration ; Shower Floor Drain <br /> Gas Fireplace _I Wood Stove ;, I Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: ' , Clothes Washer ! Medical Gas <br /> I Range Hood- Ipmo'.A a SAurr Water Heater I Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.)' Other: <br /> l _ efr44JGe(^I$OD € ib+10 A.,00R <br /> SPRINKLE”': I SUPP:'ESSIO i SYSTEM I"1Pi d6 a'I <br /> Chemical or Water INo.of Heads r <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,a • •cat 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 befor=being.>uthorized under any circumstance.I am the owner,ori am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with th..State Co'tractors Law 18.274 W and 296.200A WAC. <br /> I City of Everett Official Use Only <br /> , <br /> PERMIT# <br /> 1Ohbi 20 19- C', W f710 — 003 <br /> Owner/Authorized Age - . ature Date (Revised 9/23/2016) 'i\ <br /> (/?__ <br />