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47T PERMIT APPLICATION <br /> BUILDING / MECHANICAL / 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 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: t>'•1.E l-r_ r " 10/0(CJ7 OA l+ PROPERTY TAX#: Z'1 03/? Db 7,1 1300 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ,V•, j -' Cv "10111.1A-,1.1-1 Co y L TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Z 0 0 p to <br /> CITY s 'AIS GYL qi 'r T AA)�'1 n STATE 1 ZIP �g b!2 <br /> OWNER PHONE: 4 Z5 , 3P�8 . 9 51 5 OWNER EMAIL: —t itA 50,1 @ et/e!`a+T Cc. , e.i„( <br /> CONTRACTOR NAME: ��E Jo I„k 1 o/,—) <br /> CONTRACTOR ADDRESS: STREET Z) b 0 ) c)to.711 51 `amu I r c > 1 7 _ p <br /> CITY Li#✓/VJ ttn.)L%'t STATE 1& ?i ZIP ( (�U3 17 <br /> CONTRACTOR PHONE: .4 t 1- 74 • /AL 00 CONTRACTOR EMAIL: dActtt�LW c.11b S �� q U.`tei n' v1.,,J ,n °e_ <br /> CONTRACTOR LICENSE#(REQUIRED): 106o)t 1 IT'4.g K CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5ZO1 , <br /> PRIMARY CONTACT: El OWNER ri CONTRACTOR El OTHER(Please Specify) L2_'— <br /> CONTACT NAME: CONTACT PHONE: a 7 5 _ n4 .1 (03 p o <br /> 1/ i ) r)Avvi-E YC CONTACT EMAIL: 1��t g L t <br /> LdIa N I,an1`Ow,s-rte4- <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: i____-epi.I. IE & %wj j>rt4 r n-' Contract Price of Work: $ .•, <br /> Proposed Use of Building: C D i..4 ,.G ' \V[ '/t-t,Ai Heat Source: OGas ❑Electric DOther <br /> Building Type: DSFR-Detached ❑SFR-Attached DDuplex DMulti-Family-#of Units: .Commercial ❑Industrial <br /> Type of Project: :New DAddition ( 2emodel DRepair DT.I. ESign ❑Sprinkler ElDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: f <br /> -Toe\V L_ iN) inJ '''P't. tT SYS,C 14-4E:31--T ri, <br /> bytt.E‹_-,- Ott TS i t , 47 vr--- sY .-1.-.E.;-4".7 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): le=t,( — X2•S <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: 6icNew 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 1 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 /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Chemical or Water I INo.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 /> PERMIT# <br /> / 1 , ' 1 71 �� \�0 0 (0 <br /> � <br /> Ow.-r/Auth• '=d Agent Si.•. ure at (Revised 9/23/2016) <br /> 1/Z <br />