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4"en* PERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING I 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 i(E)everetteps@everettwa.gov I www.everettwa.govlpermits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: i 3 ieoce 611 PROPERTY TAX#: ©O/ /s i g,g.. co.700 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:iely?CoM( 0,J5 ). W. TENANT NAME( : �(1fl..f (/UATr 5 <br /> OWNER MAILING ADDRESS: STREET ?O, Sax 5q5 <br /> CRY Erlin0A/45 STATE it/4— ZIP q SOS <br /> OWNER PHONE: LZy-.Z%L/"- gat2— OWNER EMAIL: <br /> CONTRACTOR NAME: D .1- y\J(re PL(,011$1vAl6 r/-41-E417/N-Y"," <br /> CONTRACTOR ADDRESS: STREET /669// f,,,3A ,L{J. <br /> YNA)�vcr�t� w4- 9?-0 7 <br /> CITY STATE ZIP .7 <br /> CONTRACTOR PHONE: 142_5-77 ----6C7(6 7 CONTRACTOR EMAIL: efekell i Q OAA O/JITE,11,1.e7" <br /> CONTRACTOR LICENSE#(REQUIRED):pA-victriortct Ll L/r'.6z CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)C1g714I <br /> PRIMARY CONTACT: 0 OWNER .4 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: i.{.2.„ _-.2,--- ,-6,(f 4 if <br /> Et2-Y/ l OrCL-t CONTACT EMAIL: gOte 0,Da til bwt/f'ii/ ey— <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: DSFR-Detached SFR-Attached DDuplex ❑Multi-Family-#of Units: DCommercial ❑industrial <br /> Type of Project: ❑New DAddition DRemodel ❑Repair OT.I. OSign OSprinkler ODemolition DChange of Use <br /> DESCRIPTION OF WORK: _DA jT/32(.- 4 oat) <br /> /)i V ,4, 6e cc <br /> �7�' e <br /> J I <br /> i <br /> e/rid- in�TiZ- 7V m-e- Palle, i <br /> i <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> t <br /> MECHANICAL PERMIT"APPLICATION " I <br /> PLUIVlBiNG°'PERMIT APPLICATION i <br /> Type of Project: _New Addn _Alteration Repair Type of Project: _New AddnAIteratlon _Repair t <br /> #of #of #of #of <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures t <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 t <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater f Other:(tf4''j12 5E,t?it/Cz <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: I <br /> e <br /> 1 <br /> SPRINKLER/SUPPRESSION SYSTEM t <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 s <br /> Building Official before being authorized under any circumstance.lam the owner,or f am authorized by the owner of this properly to perform the work for which application is made, <br /> and t comply with the State Contractors Law 18.27 RCW and 296.200A WAG, Y <br /> City of Everett Official Use Only <br /> Al" /W/Y//5 <br /> 1Q // PE 1#) C t 2 -010 <br /> Ow r!A orized Agent Signature Date (Revised 10/12/2015) <br /> s <br />