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PERMIT APPLICATIO <br /> IIR <br /> /0011V/ 1!"-A--- <br /> BUILDING/MECHANICAL/PLUMBING/SIGN INKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 (E)everetteps©everettwa.gov www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: la 5 vl t' (Al ,,AN pszl PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision tof No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial):by rkt evv.e <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: (.,/ 1.,(‘.S. 7 v.0 �j tOWNER EMAIL: w Q vro�St o'h lf --C 6IAA <br /> CONTRACTOR NAME: ill w>a f aJ a t�.0%Aj✓II4I✓t(,e)e s4- <br /> CONTRACTOR ADDRESS: STREET0 5411-1, cF ,246 , p <br /> CITY j<' <br /> e 115 t11 STATE �U . ZIP cr8(2 03 <br /> CONTRACTOR PHONE: 41,2.5.- 5-0m_ 21.5 3 CONTRACTOR EMAIL: ;Via p// ALO yek),( , (c trot <br /> CONTRACTOR LICENSE#(REQUIRED):2-14,11 A 4V et0X)-(1)0 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER XCCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: Tes_cF LA)�dl Z(f ���( CONTACT PHONE: :L c®3, - D77 3 3 <br /> CONTACT EMAIL: iT j j c4y1 ;`tom r <br /> BUILDING PERMIT APPLICATION T L. <br /> Existing Use of Building: Contract Price of Wo .$ 7 O <br /> Proposed Use of Building:Rp � Q`[�"r' ‘44- Heat Source: ❑Ga- ❑Electric Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: -Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ['Remodel ❑Repair DTA. Sign ❑Sprinkler •Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: � 'r Len „.......7:7/,‘„4„.n <br /> iot �� <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 List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—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 /> !Chemical or Water ' (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.I am the owner,or l 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 /> /e PERM! % <br /> ()(4 01) <br /> Owner! orized Agent Signature Date (Revised <br /> 9 9 9/23/2016) <br />