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PERMIT APPLICATION <br /> /1.104P—AL <br /> BUILDIN ECHANICAL/PLUMBING/SIGN ' mRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERE i i,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps©everettwa.gov I www.everettwa.gov/permits <br /> W . _ :: -_ _ , . . :PROJECT SITE INIORMATION • ` - <br /> ` <br /> PROJECT SITE ADDRESS: 101 o jby AIL, PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision/ TTS Lot No. (attach copy of long legal description) <br /> C ONTACT INFOR <br /> „, - MAT � - <br /> .: . � _ION .. <br /> OWNER NAME: iS Cri, ai% z `l TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: vsTREEr Jo,O. &'> 641-7 <br /> CITY smSTATE OA- ZIP q 8,Q°l <br /> OWNER PHONE:-.-.4/075- 303- d oZ/ -. OWNER EMAIL:i... brefia.oan € ev,had,°rolN _M �.. ..._.._,. <br /> CONTRACTOR NAME: <br /> S'a(.C.le. KjeC.�larZGC.a `th1,U <br /> CONTRACTOR ADDRESS: STREET .3&3 a4 r, - 1 i of <br /> crrf rail_ STATE /OA- zip 98o <br /> 7/411- Q <br /> i <br /> / <br /> CONTRACTOR PHONE: p?dj- Q a/31 CONTRACTOR EMAIL: 37.5upe.ac @ CoaQST.k.)9--4- <br /> CONTRACTOR <br /> ), LCONTRACTOR LICENSE#(REQUIRED): £oUjti'I /6 ac QP CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 54,i/in <br /> PRIMARY CONTACT: OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTAC NAME: CONTACT PHONE: Qi�-'7/9 0� 3 <br /> CONTACT EMAIL: � ef_, <br /> •` `"BUILDING PERMIT APPLICATION , 75 <br /> -c-3-1. <br /> Existing Use of Building: • Contract Price of Work:$ I) sage <br /> Proposed Use of Building: Heat Source: OGas I:Electric ❑Other .OYt <br /> Building Type: DSFR-Detached ❑SFR Attached ❑Duplex OMuIti-Family#of Units: ISCCommercial IJlndustrial <br /> Type of Project: DNew DAddition ❑Remodel El Repair Ern. OSign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Ak.. ,(DGS . iC� ` ✓-e� ;(tel J <br /> ein 'R OO irks . - ,:: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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 #°f List of Fixtures #°f List of Fixtures #°f 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/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 'only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before-ng authorized under any%4. instance.I am the owner,ori am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with thr ate Contrac•rs Law 18.27' W and(e__296.200A WAC. <br /> City of Everett Official Use Only <br /> • ,00er <br /> 1‘40 F/-,z)//..8 PERMIT y } , b ) ) <br /> Ow - Autho ,e. 'gent Signature Date (Revised 10/12/2015) <br />