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ITALICATIOl—
<br /> BUILDING I MECHANICAPLEIRPMLUMBPINPGI SIGN /SPRINKLER I 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,evsrettwa.govipermits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
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<br /> PROJECT SITE ADDRESS: -2 .7. '7' e:.' /(()/T V? "-)r 1(: (\Pee (A1P '14 ROPERTY TAX if:
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<br /> LEGAL for new construction: Short Plat/subdivision Lot No, _ (attach copy of long iegai description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: V 1 c,a,,cn i 'r- 0 , .
<br /> \)k.:-.1 irl, ti, 1,1 TENANT NAME(If Commercial): M ve , .ctize•-, y-c_,Fr
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<br /> OWNER MAILING ADDRESS: STREET 2L 32, /0 c4- "1 - 4-- nt-
<br /> c,,, ev ,,yet-t- STATE tA.,..) /4 ZIP IV,2.0 8
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<br /> OWNER PHONE: Li - - IC) — ,..... 1 OWNER EMAIL: i ',...
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<br /> CONTRACTOR NAME, —,- I V A- +- -)-c-c) -) t—
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<br /> CONTRACTOR ADDRESS: STREET g .5 u k 4 t7, . i.- c\f) e-
<br /> CITY C a tcie C`';-2 v-e,As STATE 14 ZIP (1 A''. S Si
<br /> CONTRACTOR PHONE: Lf ‘? I 9Z 1 CONTRACTOR EMAIL: `S C 0 [ \./Cka;AA. 't YL,ett), ) ' P e.
<br /> CONTRACTOR LICENSE ti(REQUIRLD): C,( WA CL -'''
<br /> ./...)L-, t•A 6 CITY OF EVERETT BUSINESS LICENSE MREQUI' 0):
<br /> PRIMARY CONTACT: 0 OWNLR Ft CONTRACTOR 0 OTHER(Please Specify) TV' i004 1 016 19)0
<br /> CONTACT NAME: CONTACT PHONE: (-42.. S '314 - -)
<br /> CONTACT EMAIL:
<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: c24,5 jai IA 4-- 1' a . t) 0
<br /> Contract Price of Work:s__ ,.c
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<br /> Proposed Use of Building: 1k) ,1 i CEA*, ON C 4 Heat Source; OGas OElectric MOther
<br /> Building Type. DSFR-Detached OSFR-Attached ODuplex OMulti-Family-#of Units: OCommercial Olndustnal
<br /> Type of Project: ONew DAddition ORemodel ARepair ail, OSign CI Sprinkler ODemolition OChange of Use
<br /> DESCRIPTION OF WORK:
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<br /> 0.... \--c:Cf k NO"- t 5 row 1.Y-11 43/Lin rt?5
<br /> ASSOCIATED BUILDING PERMIT#(if applcaole)
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Type of Project: New Addn Alteration Repair Type of Pro)ect: _New Addn Alteration Repair
<br /> #of lof
<br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures
<br /> Fixtures Fixtures 0 of X of ures Fixtures Fixtures
<br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg)
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<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/Moo/etc.): Other.
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<br /> SPRINKLER / SUPPRESSION SYSTEM -
<br /> Chemical or Water 1 No,of Heads
<br /> ACKNOWLEDGEMENT'i have reviewed this appbcation and confirm the information contained herein is true and coma Work done pursuant to this permit must comply with
<br /> current7eleral,Slate,and local law, The granting of a permit only authorizes approved wort(and no deviations therefrom Deviations must first be authorized in writing from the
<br /> Buildin Official before being authorized under any circumstance lam the owner,oil am authorized by the owner of this property to perform the writ for which application is made,
<br /> and 1Ornply with the State Contractors 4.01V 18.27 f?CVV and 296 200A WAC
<br /> City of Everett Official Use Only
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<br /> , .,' : -,-( 1v•-•,-.2‘ e(1°3 I i T PERMIT OM
<br /> Owner/Authorized Agent Signature Date (Revised 9,23/2016)
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