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PERMIT APPLICATION <br /> 447rBUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 1(E)evereiteps@everettwa.gov I www,everettwa.gov/pennits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1 Y 12 J ,± St GE 4 5 3 a(v PROPERTY TAX#: <br /> LEGAL for new construction: Short Platlsubdlvision Lot No.' (attach copy of long legal description) <br /> CONTACT-INFORMATION <br /> OWNER NAME: +Ply 00,15i TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1LLQ jo�0p 121 4510( 9.r� y�� y� <br /> Cmi' r L'£:+u STATE 14.9 r I x3P q t at.!tJ <br /> OWNER PHONE: 42_5 -7L4. $ 2(7 OWNER EMAIL: <br /> CONTRACTOR NAME: 4S n In k�( , <br /> CONTRACTOR ADDRESS: STREET 1 L� '� "( c{ <br /> cc6TY f , ,,, , S(Arc ' A- zits g g 20 1 <br /> CONTRACTOR PHONE: 425 2fjcc Qc 5(:) CONTRACTOR EMAIL`{ LQ e, C V 4V 2,1,+ rt .co ) ` <br /> CONTRACTOR LICENSE#(REOUIRED): qesi -b ..cSR t4.. CITY OF EVERE t t BUSINESS LICENSE#(REQUIRED): 1067 9 <br /> PRIMARY CONTACT: 0 OWNER (CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 1426 2.59' O5-"D <br /> CONTACT EMAIL:&blip a e CIA kjU t,rt .C fl'7 <br /> BUILDING PERMIT APPLICATION `"�"+� Ili 1 <br /> Existing Use of Building: Contract Price of Work:$ 3 2 .0 0 _-- <br /> Proposed Use of Building: Heat Source: Aas 0 Electric ❑Other <br /> Building Type: NtSFR-Dotached ❑SFR-Attached ❑Duplex 0Multi-Family4 of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> t €191 cL3 furn.a <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 <br /> Fixtures List of Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> 1 '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 /> P _ <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 l SUPPRESSION SYSTEM <br /> • <br /> Chemical or Water 1 ,No.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./am the owner,or/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 /> L1.: l • I.7 � � <br /> PE � <br /> Lk <br /> T �� <br /> Ow er!Authorized Age Signature Date fFtevlse f 9/23/2016) <br />