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PERMIT APPLtCAT10� <br /> BUILDIN��ECHANICAL/ PLUMBING/SIGt�PRINKLER/ �EMOUTIQN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 • <br /> (P)42b-257-8810 � FAX 425-257-8857 {(E)everetteps@everettwa.gov( www.everettwa.govlpermits <br /> (Biue or Black Ink Onty Piease) PROJECT SITE INFORMATION <br /> PR�.IEC7 SITE ADDRESS: �j�iQ (JpZ,�L S�`, #' ���e PROPERTY TAX#: $QV►`j (7p�Oc�QQ <br /> LEGAL for new construction_ Short PlaUsubdivfsion Lot No. (attach copy of iong legai description) <br /> CONTACT INFORMATlON <br /> " OWNER NAME: L/�Gt� �J� �3L��q V{LL.A i».�.•�. TENANT NAME(If Commercialj: i�✓I�DEI. HonnE <br /> � OWNER MAILING ADDRESS: s�er 7�o't� 5�. a7�-5�S?�/TF oZ�3 <br /> CITY M��C�R SS�.{1ND STATE �.UA- ZIP F�IO <br /> OWNERRHONE: �a�., � , a OWNEREMAI�: c�U�.{E pAT�Nf4REf�l.ksT/�T�.�'A1Yl <br /> CONTRACTORNAME; G ANCC� nhi 'T {OI�S <br /> CONTRACTOR ADDRESS: s�Er 0 '� ���f��.�, <br /> �� SLAT LE: SSATE Wy�S. �p �i � <br /> CONTRACTOR PHONE: oZO�"�}IoZ•(S(a(7� CONTRACTOR EMAtL: C,K�}R���C��/�'1/}j0..Ct�M <br /> CONTRACTOR LICEIVSE#(REQUIRED): CA R RA����C� ClTY OF EVEF2ETT BUSINESS UCENSE#(REQlllREDy:��� <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACTNAfllIE: CONTACTPNONE: �•�}ja• Q��� <br /> G���� �� �������� CONTACT EMAtL: <br /> CK�A t�t�AN�OC�M✓atL.COtor1 <br /> BUiLDING PERMIT APPLlCATiON <br /> Existing Use of Bu�tding: Coniract Price of Work:$ t NO NIL� O �.OU <br /> Proposed Use of Suildin : Heat Source: �Cas ❑Electric ❑Other <br /> Building T e: FR-Detached ❑S�F2-Attached ❑Dupiex ❑Multi-Family-#of Units: DCommercial �tndustriat <br /> Ty of Project: ❑New ❑Addition ❑Remodel �Ftepair C1T.1_ �Sign ❑Sprinkler �Demolifion �Change of Use <br /> DESCRIPTtON OF WORK: <br /> - —LJ�S��1a..-L_�1C-�-_IM�4n{t1.F�►CTtJR�fJ__�1t�ri�--.I.N.—�XJs_T__1nJG----- <br /> _ __. _.__._------- - -MA.N�FACr�Q NOt+n�_ I�i4RK _------__ _. _ -- <br /> ASSOCtATED BUILDING PERMIT# if ap licable): <br /> MECHANICAL PERMIT APPLICATION PLUMBIWG PERMtT APPLICATION <br /> Type of Pcoject: _New Addn Alteration _Repair Type of Project: Wew Addn Alteration Repair <br /> #of � <br /> ��� List of Flxtures Fixtures usf of Fixtures #°f Lisf of Fixtures #of List of f�xtures <br /> ���+!�es Ffxtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(lnside Bidg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Baiter Lavaiory(Wash Basin) Drinking Fountain <br /> Water Heater Refigeration Shower Fioor Drain <br /> Gas Fireplace Wood Stove }Gtchen Sink&Disposa! Grease Trap <br /> Gas Ran e Ducting Dishwasher Roof Drains <br /> Clotthes Dryer Hookups Other. Clothes Washer Medicai Gas <br /> Range Hood Water Neater Other: <br /> Exhaust Fan Sink{ServiceBaNMop/etc.) Oiher. <br /> SPRlNKLER/SUPPRESSION SYSTEM <br /> IVumDer of Heads <br /> acrcrvowr.EDGEM�nrr-�nave reviewed tnis appfication and confirm the information coniained herein is true and eorreci.Work done pursuant to fhis permit must comply with <br /> currenf fedefat,State,and►OCe(tBW.Th2 gr2l►ting of a pe�tnit only authorizes approved work and no deviaGons therefrom.Deviafions must first be authorized in writing finm the <br /> Building OfBcial beTore being authorized under any circomsfance_!am the owner or 1 a'»authorized by the owoer of this property ta perform the work for whiCh gppllcatioq!S made, <br /> and 1 comply with the Stafe Cor►trdctors Law f8.27 RCW and 296.200A WAC. <br /> City of Everett O�cial Use Only <br /> PERMIT# � I �� <br /> /'�O-�°-' ll!' � G/ .--- <br /> @�eslAuthoriz Agent S�gnature Date (Revised 5/24/2Q16) <br /> � <br />