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047-1- PERMIT APPLICATION <br /> BUILDING ECHANICAL/ PLUMBING / SIGN RINKLER 1 DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 6 oath S I. # 3 75 PROPERTY TAX#: gory I cO 3Oi 500 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: LAG°° Da PLATA VI LLA L.L.C. TENANT NAME(If Commercial): MODEL. tIOMIE <br /> OWNER MAILING ADDRESS: STREET 7426 SE. 0Zith-ST. SV/TIC o2N3 <br /> CITY fERUER ISLANO STATE WA- zip 9 'o o <br /> OWNER PHONE: ic..16, (all ' y4aa OWNER EMAIL: ICJ)-I EePATINAREA1.' 5T/AT�:.C.OIVI <br /> CONTRACTOR NAME: GAARA NCO Cc*bTRoCTICK <br /> CONTRACTOR ADDRESS: STREET 110,0 i sri.,we 5l. <br /> cITY SEA Q TLL STATE Ui/k ZIP 9811( <br /> CONTRACTOR PHONE: o/OG'4 I • O6,O4 CONTRACTOR EMAIL: t„KCA R14AMOQGfa /U L_COM <br /> CONTRACTOR LICENSE#(REQUIRED): CA R RAC. OCG C CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ^-17, <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: mfr. 41Q. ®(0� <br /> GEOAGE Q. CARR,ANC0 <br /> CONTACT EMAIL: CKCA PillANC.0 MAIL.COI°t9 <br /> I BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 111 .Ottt' <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project:'New ❑Addition ❑Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> IINSTALL Ia°pz; Ga' 0\41.7 TALE CH IA Pohl' <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 #of #of #of <br /> Fixtures List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures <br /> 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 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. I am the owner,or I am 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 /> PERMIT# <br /> 6:e° t< �c�r /2-o-- b I420(e- tiD I <br /> Queer/Authoriz Agent Signature Date (Revised 5/20/2016) <br /> \I 2— <br />