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/110 ---a <br /> III PERMIT APPLICATION■ 1 <br /> BUILDING /MECHANICAL/PLUMBING/SIGN/SPRINK DOR -R <br /> CITY OF EVERETT PERMIT SERVICES MAI <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> ((�( T (P)425-257-8810 FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> _ �YR'iF i 0 y 1�Ti�rra��i"i '$P�" pct" kY++s�-,� P5 r'V Pb i -.?}. i t� �n it 4. I i'i� Ya 9 i 7 1 i� 'F <br /> �; m� �: �K I', �"i i', <br /> QJRO 1 �'� Id►fil <br /> �.. A' ' = ._ ';�; r�r= .N_ `� .r �� �. �N �9: �.0, .� x� t _tom.. <br /> PROJECT SITE ADDRESS:a/Wei /Or <br /> J 35 0)�,L 54AROPERTY TAX#:002.1 O/'�{/` V <br /> LEGAL for new construction: Short Pll''aat/subdivisio/n/ __ U Y�D Lot No. (�(J(attach copy of long legal/ description) <br /> ANG) ; 9 n�_' `' s p 'i�' p N'a �@ (�"� �i ttt [ i " I�, ii 9 �U vii i;. 1 : °"E <br /> ,�� � ,�� ; w � � i'`. O01�TAC'�"�1�IFfr1�MAT10 t <br /> e <br /> OWNER NAME:jam' Prig__ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET q8(161 21,5`t PR $E Unif 55-- /, //��Z� <br /> CITY Ewa It' STATE/ /VV��/ ZIP 93 7 <br /> OWNER PHONE:5va—Az D'LiQ OWNER EMAIL: ,V <br /> CONTRACTOR NAMECIU� r`4 <br /> CONTRACTOR ADDRESS: STREET l 1 6 3�J I (/(� <br /> CITY wood- k,,,,_ 2rp STATE 0.19-Na7J ZIP �r,,�(/T <br /> CONTRACTOR PHONE:LIQ, -- •-113 4 CONTRACTOR EMAIL:inch `� V 1-, l <br /> C Q <br /> CONTRACTOR LICENSE#(REQUIRED): L 21 ( Ff 0., CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 27V <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> C TACT NAME: CONTACT PHONE:-frri ! —7/3 <br /> Minna h Y e1 7 '. CONTACT EMAIL: 1 �� /JP / im'�� <br /> + �' �, ! irk �iiii � � ., � >..�,. ��.�: an.- i t g E tipi iil S) aSi p i n � I <br /> _ w ?''.BWLDlfj:E PERM rt A*P�LIIC .IO tt -"° hN-' , I <br /> Existing Use of Building: Contract Price of Work:$ .O,1(')O,W./ <br /> Proposed Use of Building: Heat Source: El Gas ❑Electric ❑Other <br /> Building Type: XilFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel .'Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: , <br /> Iik and V.i nc Ana ce aod .41( tiop <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 'IdP' <br /> MECHANICAL'PERMIT,APxPLICATIO 1,',..,,ei' �� l,fC i ;'+t4.PLUMBIN`G'PER,MIT I;PPLICATION4 ?;'V:'"o qSd,'$'l <br /> Type of Project: _New _ Addn _Alteration.epair 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 /> 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 <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 /> 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 <br /> Building Official before being authorized under any circumstance.1 am the owner,or lam 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 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> / --ihatio <br /> PERM IM 60,—) 0.4(0 <br /> 0 -r - +.•• • Signature Date (Revised 10/12/2015) <br />