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PERMIT APPLICATION <br /> BUILDING I 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 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink,Only Picasso) PROJECT SITE INFORMATION 2 <br /> PROJECT SITE ADDRESS: /01(,),j' /i f" 4 Pc SL SFe IPI 1:Vcrc f''f /.o ` ,0-4')//o <br /> PROPERTY TAX#: .3 <br /> LEGAL for new construction. Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION n <br /> OWNER NAME: MIA/ <br /> (/Uf6fhe 4,4 t. 1)5c,,,,,, 4.1,..c.... TENANT NAME[ (If Commercial): /7/y/ - <br /> OWNER MAILING ADDRESS: STREET Ze)(2/ /9 I' 1/10 % �l C- ,kd/S '7 � � 'J <br /> CITY i V e vt ✓�V/ <br /> /i- 1 STATE i r ZIP 7?2-Of <br /> OWNER PHONE: '`/ <br /> " 3 ..37('GO OWNER EMAIL: C"7 7E4vi-�' fe Cl/7 k1, C G frN <br /> CONTRACTOR NAME: Set-1/!CG RA m 4//)'j ?a `)KRIS/ hie . <br /> l / <br /> CONTRACTOR ADDRESS: STREET I oC /7 6 ) S/ fit/ fir 1/ 3 <br /> city y/-1 Ili) GQvd STATE 11779', ZIP'?& f9 <br /> 3 <br /> CONTRACTOR PHONE: /15— 6'(B ?r/� / CONTRACTOR EMAIL: PG(reAR$'/%7)& ViCl1 pit , /7 el— <br /> CONTRACTOR LICENSE#(REQUIRED): 5 E? V I P1-L 9 rJ' 3) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6 00 2...2— <br /> PRIMARY CONTACT: 0 OWNER PLCONTRACTOR 0 OTHER(Please Specify) <br /> CO CT NAME:l v` `L CONTACT PHONE: q„2. F t%p tiO 2 I 2.,-)f Dlch l/l5 i 11 CONTACT EMAIL: Pat-pi S e l" vice 121) . /1 d— <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Coni m erc-al Contract Price of Work: $ /t , aw <br /> Proposed Use of Building: Heat Source: ❑Gas 0 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: ...7017L 1 r 14 <br /> m b,, ! h 41-J bR A4 r a o'n- cr F-101 <br /> br �Arov/ - R <br /> ASSOCIATED BUILDING PERMIT#(if applicable): (6U I Oq ~ ©O1 <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 #01 List of Fixtures #of List of Fixtures of /r _ 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 /> Gas Piping Boiler I Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove 7 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 I`SUPPRESSION SYSTEM <br /> Chemical or Water I No.of Heads <br /> ACKNO- •DGEMENT:t have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant 10 this permit must comply with <br /> curren fed: :t,state,an. . .l law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Build! g a i • I before•.= .autho •:d under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and I o•pl ith the. - - I on1ra • Law 18.27 RCW and Z96.200A WAG. <br /> I 1t City of Everett Official Use Only <br /> l / / &/( ? PER IT ( ( Q <br /> r 1 <br /> Owner/Authorized Agent Signature (Revised 9/23/2016) <br />