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BUILDING / �HANiCAL I PLUMBING I SIGN I SPRINKLER 1 DI.muLI r wiv <br /> ;kli�`,,+',/`'�� CITY OF EVE.RETT PERMIT SERVICES <br /> I , 3200 CEDAR STREET,EVERETT,WA 98201— <br /> (P) <br /> 8201 —(P)425-257-8810 I FAX 425-257-8857 1(E)everetteps©everettwa.gov I www.everettwa.gov/permits <br /> INFORMATION <br /> (Blue or Black Ink Only Please) PROJECT SITE � IPROPERTY TAX#: ,21736 S7 �00302500PROJECT SITE ADDRESS: 6 t 1'L* Sr A t(i ) <br /> Lot No. (attach copy of long legal description) <br /> LEGAL for new construction: Short' Plat/subdivision <br /> CONTACT INFORMATION <br /> OWNER NAME: rry PtitrA- I"I ,L,cr <br /> ENANT NAME(If Commercial): 0Pe1-- H041 <br /> OWNER MAILING ADDRESS: STREET 7'42k, 'fie 7 i' sr. sump: IA.* <br /> /,, <br /> c I ite R+4tsL�. 1 c),4414.1:14 STATSTATEit y� ZIP 176 <br /> OWNER PHONE: 4/21i- 941 - 8'-12.2„ OWNER EMAIL: 71,114� 6-Clem-1 1..$erR 'E•&M <br /> S'fi"EVC X ).ft.-Er L- -. Co <br /> CONTRACTOR NAME: n�;1pC'1 i.9 t��.C2-- <br /> CONTRACTOR ADDRESS: STREET T I ZGD ' 6 i-. SuITG <br /> crY \'-eltLe• SCSTATE <br /> • + <br /> ZIP 9 Q <br /> � <br /> Q <br /> CONTRACTOR PHONE: q2s"` Z ii-c,(02 /_ CONTRACTOR EMAIL: I) d <br /> it .t1Aq.r L•6011/1 , <br /> CONTRACTOR LICENSE#(REQUIRED): A�,I /S3 ,CITY OF EVERETT BU ESS LI ENSE#( RUtRED): <br /> PRIMARY CONTACT: Cl OWNER iiCCONTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4/2 s--2$(- 6 2 <br /> CI/ 50— CONTACT EMAIL: L led (pr.:, 1 •CO/I/1 <br /> BUILDING PERMIT APPLICATION <br /> Existin• Use of Buildin•: <br /> Contract Price of Work:$I ..i 411 <br /> Heat Source: CIGas ClElectric ❑Other._..._.. <br /> Proposed Use of Building: ©Commercial Cllndustrial <br /> Buildin•'Tr•e: ❑SFR-Detached CISFR-Attached ❑Du.lex ❑Multi-Famii 4 of Units: <br /> T •e of Proect ONew °Addition °Remodel °Re•air OT.I. CiSi•n OS.rinkler °Demolition OChan.e of Use <br /> DESCRIPTION OF WORK: j N�•�- Lcivgpo(R-T T moo ur erLd,-1 <br /> ourerC1 u It. ��6: <br /> ASSOCIATED BUILDING PERMIT# If a.•livable: PLUMBING PERMIT APPLICATION <br /> MECHANICAL PERMIT APPLICATION <br /> iteration Repair Type of Project: ,._..New _Addn _Alteration _Repair <br /> Type of Protect: Addn ...,..A #of #of List of Fixtures <br /> List of Fixtures <br /> List of Fixtures Fixtures List of Fixtures Fixtures Fixtures Beddow Preventer(Inside Bldg) <br /> Fixtures Toilet <br /> A/C-Air Handlin• Units. Heat Pum• Urinal <br /> Unit Heater Bathtub <br /> Forced Air S stems Lavatory(Wash Basin) Drinking Fountain <br /> Gas Pi•ins Boiler Floor Drain <br /> Water Heater Refri•eration Shower RWoodanee Ductin•Stove Kitchen Sink&Disposal Grease.Trap <br /> Gas R <br /> Gas ire•laceDishwasher Roof Drains <br /> Medica:Gas <br /> Other: Clothes Washer Medic: <br /> Clothes D er Hookup& Water Heater <br /> ther <br /> Exh u t Hood Sink Service/Bar/Mo./etc. Other: <br /> Exhaust Fan <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Chomlcal or Water No.of Heads <br /> ACKNOWLEDGEMENT:i have reviewed this application and confirm the information <br /> iond workined and herein <br /> deviationsiis true and mt Deviatidone ons don mupursuant t o this pezed n writing from with <br /> currentthe <br /> state,r and local law.The ndering of a permit oany cirycumstance. <br /> mauthorizesthe <br /> app <br /> Building Official before being authorized Law X8,27 RCW and 296,200AhWAGner,or 1 am authorized by the owner of this property to perform the work for which application Is made, <br /> and!corn',with the State Contractors 4 9 PERMI City of Everett Official Use Only 1 <br /> .r C° 1 1 <br /> - (Revised 9/23/2016) <br /> Ownei Author zed Agent Signature <br /> Date <br />