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PERMIT APPLICATION <br /> "1111/44.44•*//---g BUILDING /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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:,7 Acie ''(e /lr j)"e__ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME. 4)1)1i./vJ / i TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STRE /e 49 e/'-- <br /> CITY l' STATE1 (_).___. q., ,,,?e),,, <br /> OWNER PHONE:00.46 'V Li D OWNER EMAIL:&f 1Ijed?£Aejk><'�LL •CC/iii <br /> CONTRACTOR NAME: I-0 ® ,,�/ " TGt'`i�S <br /> II-0 YC�'C.C� <br /> CONTRACTOR ADDRESS: STREET 4601) 5 i 3(.1 <br /> /1-1` P..„„...e <br /> ciTzt STA7a zip /4 <br /> CONTRACTOR PHONE 6 Z S2 /s1.-.1 CONTRACTOR EMAIL:���J�( ( J(ci1/;d -, of C'S'co)...,.._ <br /> CONTRACTOR LICENSE#(REQUIRED): >✓ D{VL�j' 06 CITY OF EVERETT BUSINESS LICENSE#( a -. D):O(IAD S3 <br /> PRIMARY CONTACT: 0 OWNER XCONTRACTOR 0 OTHER(Please Specify) <br /> CON ACT NAME: CONTACT PHONE: 0 ) L 0 <br /> 011ie- <br /> CONTACT U(CONTACT EMAIL:npnnf`e () / t c /" C_CGli <br /> —� BUILDING PERMIT APPLICATION � <br /> Existing Use of Building: ` Contract Price of W. <br /> Proposed Use of Building: 1, - Heat Sourc ■Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Du. ❑Mul' --mily-#of Units: DCommercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel ❑Repair P . . Ili '-• ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRI TION OF WORK: <br /> �� v LA l'''''- <br /> / <br /> ASSOCIATED BUILDING PERMIT : applicable): <br /> 'k` MECHANICAL IfERMIT APPLICATI• PLUMBING PERMIT APPLICATION <br /> Type Project: _New_ Addn _Alteration _Repair 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 Fixt -s Fixtures Fixtures <br /> ‘ —Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forc •Air Systems Unit Heater Bathtub Urinal <br /> Gas Pi.' g Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water He: er Refrigeration Shower Floor Drain <br /> Gas Firepla Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes D',er Hoo. is Other: Clothes Washer Medical Gas <br /> Range -ood Water Heater I Other: 405(E4e-SemA _ <br /> Exh-at Fan Sink(Service/Bar/Mop/etc.) Other: <br /> RINKLER/SUPPRESS ,N SYSTEM <br /> Chemical or Water I No.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 /> curre ederal,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 /> Buil.ing s icial befo -being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> an I corn. with th-S:e Com-ctors Law 18.27 RCW and 296.200A WAC. <br /> I ' City of Everett Official Use Only <br /> IPERMIT# <br /> OP 4 —. .44 0 ris4g-Olii <br /> Owne - . ized Agent Signature Date (Revised 9/23/2016) <br />