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PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/ PLUMBING I SIGN I SPRINKLER/ DEMOLITION <br /> 3410.7" CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 i FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITEIINN ORMATION <br /> PROJECT SITE ADDRESS: 1l (1./ .:;''‘..512049 L� iC PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION - ---\ <br /> s <br /> OWNER NAME: Ci/r,, �1G�� TENA/NT NAME(If CommerceS f �.Gjf'PY-! <br /> OWNER MAILING ADDRESS: STREET/o.7� ( 41 <br /> t P liP �/"7 <br /> CITY 6/9/416/ CJ STP, .�' - ..._ZIP /_ / <br /> • <br /> OWNER PHONE: '2-S -��c- q/ ; , OWNER EMAIL: / / �, 4, /��V � // <br /> CONTRACTOR NAME: 6..- 4/.4e, FrI'- - <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: 1,925'.--- V c— 906 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CO CT NAME: CONTACT PHONE: <br /> `(�C //A, gt -e--- CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> EDO <br /> Existing Use of Building: Contract Price of Work:$ 1:3—00(...). <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use . <br /> DESCRIPTION OF WORK: <br /> VA1Jf.I cc 'ALL tit' - xlkir6 C ni- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 6/1,6dA , x JO 1 in ci1 Le h lel <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 /> NC—Air Handling Units Heat Pump p1, 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�,,/�� 1 <br /> Range Hood / Water Heater / Other: tegra4tZC , - ,, ) <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: �1o'J�/'jp/a'j,�fZ/� <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 roust 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 properly to perform the work for which application is made, <br /> and!comply with t ntractors Law 18.27 RCW and 296.200A WAC. <br /> - City of Everett Official Use Only PERMIT# <br /> 007r7Oi —cô�p� <br /> Owner/Authorized Agent Signature Date (Revised 9/23/016) <br />