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PERMIT APPLICATION <br /> BUILDING I MECHANICAL i PLUMBING/SIGN i SPRINKLER I DEMOLITION • <br /> CJD(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 l Www.everettwa.gov/permits <br /> (I4 die or M3isick relk Qn[y.1 9e se) ' - PR®JEC5 S Tt 1NFOL t1i1ATION . <br /> PROJECT SITE ADDRESS: le 1 C., -- `'7 /r PROPERTY TAX#: <br /> LEGAL for new construction: Short Plattsubdlvislon Lot No. (attach copy of lone legal description) <br /> _. . . .CONTACT 1E IPORMATION • • • • . <br /> OWNER NAME: 1, ,P 5 ('LQ TENANT NAME(If Commercial): _ — <br /> OWNER MAILING ADDRESS: STREET �°2g((0..-7 I/ ' "' p q • <br /> cm' 'tiUo •G STATE WA. ZIP Q T Z )( <br /> OWNER PHONE °Z! . 6 ---7;• OWNER EMAIL: <br /> CONTRACTOR NAME: E U .6(p.• .,IV 6 rwT( ea-7-yt, -c. <br /> CONTRACTOR ADDRESS: STREET °2-120 Olt-I Olt-IFt,. AU <br /> r nUg' (A,LA--y awe ( - zip /S20( <br /> 4 <br /> CONTRACTOR PHONE: -5.252-'s(14 . 'CONTRACTOR EMAiL: <br /> CONTRACTOR LICENSE#(REQUIRED): gr(J `Z4..jS 0214 CITY OP EVERETT BUSINESS LICENSE#(REQUIRED): 06 d y' <br /> PRIMARY CONTACT: El OWNER I kCONTRACTOR Q OTHER(Please Specify) / • <br /> CONTACT NAME: CONTACT PHONE: 4 2 5-24-2-3/1(y' <br /> ) CONTACT EMAIL: <br /> .' _ . ' • : . . . • • i' `• n.iii.D914)e.ektiIiI.T A19.LiCA` i.ot i • • . . ' '..•• . . , <br /> Existing Use of Building: I Contract Price of Work:$ 21490, -632' <br /> Proposed Use of Building: Heat Source: ❑Gas ArtIpcfrio ❑Other <br /> Building Type:COFR Detached ESFR-Attached ClDuplex ClMultl-Family-#of Units: UCommercial Olndusfrial <br /> Type of Project: ElNew ClAdditton EIRemodel ❑Repair /4.1. IJStgn CDSprinkler C(Demolif(on El Change of Use <br /> DESCRIPTION OF WORK: � _/I��S i� � I �`'Std <br /> ASSOCIATED BUILDING PERMIT#(if applicable): _- <br /> [IlECh ANICAL, Itr11TAPP ,1d�i ION , . • • . PLUMEING PE11MITAPPLICATION • <br /> Type of Project: New Addn _Alteration Repair Type of Project: New Addn Alteration Repair <br /> #°f List of Fixtures #°f List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-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 /> itWater 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 S Y .EIV( _ ' ' <br /> I Number of Heads <br /> ACKNOWLEDGEMENT l have reviewed this application and confirm the information contained herein is five 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.lam the owner,or/am authorized by the owner of this property to perform the work for which eppifcat/on is made, <br /> and I comply with the State Contractors Law 18.27RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PE <br /> ••••<....--1--......- S*2' q°-`1 -( 1 <br /> m socc. ___0(,_ 1 <br /> Owner/Authorized Agent Signature Date (Revised 6/20/2018) • <br />