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II PERMIT APPL.ICATIO ,�� <br /> ,111010•--- <br /> i='UIL.DINL HIIECHANICAL/ PLUM=ING /SIGN 4kINKLER/ 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 /> (Blare or E=,lack Ink Only Please) Pi.OJIECT SITE IN ORMATUN <br /> PROJECT SITE ADDRESS: 5i ,- 14 Cit_f y,yt a )2 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> C s NTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): 2,t i/'?_f 1--,!) C <br /> OWNER MAILING ADDRESS: STREET <br /> CRY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Cle,"8e-01--- 0 ) CC,--k f , <br /> CONTRACTOR ADDRESS: STREET t 5 73 U r j +f'�-" J <br /> cITY 1 4 ,��`e ) STATE td, ZIP y,1 <br /> CONTRACTOR PHONE: r w_ . 0 ONTRACTOR EMAIL: / / • LI '' 40r�r Ir ,.\ <br /> SP <br /> CONTRACTOR LICENSE#(REQUIRED):Cre�� �,� ,S^/�/ CITY OF EVERETT BUSINESS LICENSE#(REQU '- D):� �IIf(_� � <br /> PRIMARY CONTACT: 0 OWNER D ONTRACTOR 0 OTHER(Please Specify) ‘\ I CP 3 <br /> CONTACT NAME: CONTACT PHONE: 2 O ‘ ..2 (-07 <br /> Pap/ap/ Pic. �O C) Y) CONTACT EMAIL: <br /> 9 BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ .5'00' <br /> d j <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: DSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: New ❑Addition ❑Remodel ❑Repair DT.I. ❑Sign ❑Sprinkler ❑Demolition DChange of Use <br /> DESCRIPTION O WORK: <br /> COf 7/1PiAll <br /> R®4/,e a nj Pr7:1_, <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 #of List of Fixtures List of Fixtures #of List of Fixtures #°f 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 /> 3Gas 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 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.l 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. RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> lI IDEa,...00_ <br /> Owner/Authorized Agen SY ignature Date (Revisedl9/23/2016) <br />