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PERMIT APPLICATI <br /> BUIL.DIAr1ECHANICAL/ PLUMBING!SIG RINKLER/DEMOLITIOIV <br /> CITY OF EVERETT PERMIT SERV <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 ((E)everetteps@everetlwa.gov� www.everettwa.govlpermits <br /> Btue or BIacK InK Only Ptease) PROJECT SITE ITIFORMATION <br /> PROJECT SITE ADDRESS: �j�Q r�pZ,�. S�; � �'� PROPERTY TAX#: $QV'��(�p�0o�,�Qp <br /> LEGAt.for new construction: Short PlaUsubdivision lot tVo. (attach copy of long legal descnptian) <br /> CONTACT INFORMATION <br /> OWNER NAME: L/�1Gd Q� pL/�TA V)LI./�► i...0.•�. TENANT NAME(if Commercial): i�v�Ej, }10ME <br /> OWNER MAILING ADDRESS: s-r�etr 7�10'�� 5�. a7�-5T. svrjE aB <br /> �� n���cCR aSi.pND STATE WA- � gp <br /> OWWERPHONE: ��,b., ' ,+ a OWf�EREMAIL: crT(J}.�� ATiNARFAi.rsT/�T�.�AIKI <br /> CONTRACTORNAME: C ANCn C.t�hi �T 101� <br /> CONTRACTOR ADDRESS: 5�� � -p �!�"��. ��, <br /> CRY S�AT L� STATE �PT- ZIP 8I 4j <br /> CONTRACTOR PHONE: oZO�"�}(o�T• (5(pO�. CONTRACTOR EMAtL: C,ICCJ��(�A�dC(���W1O}jl.CL�l111 <br /> GONTRACT�R LICENSE'#(REQUIRED): C+a R R/�'`�rvra C T CITY OF EVERETT BUSiNESS LICENSE#{REQUlRED):D�7`{� <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑�THER{Please Spec'ify) <br /> CONTACT NAl1AE: CON7ACT PHONE: a��ja• Q��) <br /> GEO�G�' Q, CAI�F��ClSC.� CONTACT EMAIL: CKCAI���/�NC�M/�IL•COIof� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 770b.0� <br /> Proposed Use of Buiiding: Heat Source: �Gas ❑Eleciric ❑Other <br /> Buiidin Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of U�its: ❑Commerciai ❑Industrial <br /> T of Project: ❑New �Addition ORemodel ❑Repair [7T_i_ ❑Sign ❑Sprinkier ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> _ ---.____.______�_ntat���_� �a'�c_96'_ M�Aial.s CAn Pogr aN �x�sr�N G <br /> _.__ M91_r�UF4C-�U_RE_A--J�OML=--_ __.__ __-- - _ - <br /> ASSOCIATED BUILDING PERMIT# i#applicabte: <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATIQN <br /> Type of Project: _New _ Addn Aiteretion _Repair Type of Project: New Addn Aiteration Repair <br /> #of <br /> Fj�� tist of Fixtures #�f List of�xtures #�f �ist of Fixtures #of <br /> Flxtures Fixtures Fixfures Cisf of Fixtures <br /> R/C—Air Handlin Units Heat Pump Toilet 8ackflow Prevenfer(inside Bidg <br /> Forced Air Systems Unit Heater Bathtub urinai <br /> Gas Pipin Boiler Lavatory(Wash Basin Drinking Fountain <br /> Water Heater Refri eration Shower Fioor Drain <br /> Gas Freplace Wood Stove FGtchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothe5 Washer Medicai Gas <br /> Range Hood Water Heater Other. <br /> Exhaust Fan Sink(Service/Bar/Mop/eic.) Oiher. <br /> SPRINKLER!SUPPRESStON SYSTEM <br /> Number of Heads <br /> aCKrvowtEOGEn�fEnrT.•�nave raviewed this apptication and confirm the information contained herein is true and correcL Work done pursuant to this permit must comply with <br /> currenr federa7,state,attd(OC8118W.Tlte grallting of a permit only authorizes approved work and no deviations fherefrom.Deviations musf first be authorized in wlitfng from the <br /> Buflding OtliCie!6ef0►e bBing authorized under any ciroumsfance.1 am fha ow»er,or 1 am authorized by fhe owner of ihis pioperty to perlorm the work for which appllc9tioll is mad6, <br /> and!comply with the Stafe Confractors Law 18.27 RCW and 296.200A WAC. <br /> City of Evereft Officiaf Use Onty <br /> PERMIl'# � ` � Q <br /> C�JY �' �/1 <br /> �r/Authoriz Aget�t 5�gnature Date (Revised 5/20/2016) <br /> t�`/^?, <br />