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PERMIT APPLICATION <br /> ` BUILDI ECHANICAL I PLUMBING/SIGN I SPRINKLER/ DEMOLITION <br /> 41,41111111a 2 <br /> CITY OF EVERE I I 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 /> "Fat LP IP 67 4 r r PROJECTgSITE INFORMATIONr ,✓ ,` <br /> PQ 300 T warrSITE DMALL, plat vO, g:Vtraleil 981�g PROPERTY TAX#: ZI/©y 't Tv.`Qe7 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: rdt.5. -5a,.bctara � hcow TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS:do STREET 6'1714. ria!)ille mesJt I 24'9 C. ,e�„C/fib sv, qedoes <br /> CITY srL.'f STATE(,,LlA ZIP 151 p'Z. <br /> OWNER PHONE: 004. 5etc. 3254) OWNER EMAIL: tuewvtAR.Cr, 12171.4 095er-' ki <br /> CONTRACTOR NAME: -"re,p <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS UCENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 'OTHER(Please Specify) gDViver Arvin Avzorrgoo <br /> CONTACT NAME: CONTACT PHONE: �6 , , I.f7 , 7-24,53 <br /> 'RoD !'itG(4O (- CONTACT EMAIL: yrtd10., 50ifncreirbUr.cO <br /> BUILDING PERMIT APPLICATION <br /> t <br /> Existing Use of Building: Ararfvyte,j4 Contract Price of Work:$ e' L'inalli FlPt' — <br /> Proposed Use of Building: r-h ► -1--S Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex f41ulti-Family-#of Units: ❑Commercial ❑In+ trial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change o 'se <br /> DESCRIPTION OF WORK: .0 116111 <br /> Enve/ore 1z024,40-0 rr117ra�-j-r 0.au' Uvel �1).0 ci-" <br /> ev <br /> t� �et'1) n1 fVecie<ftiole PG�r r resi re,'"A C1� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 4 t t9(62I <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 #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures 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 Water Heater Other:( <br /> Exhaust Fan Sink(Service/Bar/tvlop/etc.) Other: <br /> SPRINKLER I 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 circumstance.I am the owner,or!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 /> 00 City of Everett Official Use Only <br /> PEN# <br /> n 0 1...... 040 <br /> it <br /> 71407 <br /> Ow r/A thorized Agent Signature D e (Revis 10/12/2015) <br /> II <br />