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PERMIT APPLICATION <br /> OLTBUILDING!MECHANICAL! PLUMBING I SIGN /SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov f www.evereitwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:111)1 391t1 SL e ft 1,OCf I ,PROPERTY TAX#:Cbt41 Cl eb90 1 f)D <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME <br /> �.--Xt•.•Fi 1 L.- TENANT NAME(If Commercial): <br /> unser MAILING ADDRESS: Reer 9111 (, <br /> CITY Fejt c. 0.3)4�/'� <br /> STATE ZIP <br /> OWNER PHONE: 5.. 5475-,5(I-1 OWNER EMAIL: <br /> CONTRACTOR NAME: w4541/U6jj jtl.l w 4,-1- L H A &j <br /> CONTRACTOR ADDRESS: STREET 17I 2. 11(,'- kits 56 PO ,box 5%2U g <br /> CITY p tn J'tf fi _ STATE el/4' zry qIcii 5 <br /> CONTRACTOR PHONE: 4 Z6 483— 1 g7/ CONTRACTOR EMAIL: 4 (f f} 'V/A-C (46thil((,� ton <br /> CONTRACTOR LICENSE#(REQUIRED): Wil-WAVIOP ICiTY OF EVERETT BUSINESS LICENSE*(REQUIRED): 05 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT� rNAME �p I CONTACT PHONE: f213--C/8 7/ <br /> i <br /> ‘.:..111-CCI 0 as CONTACT EMAIL: j,(/' <br /> �4U4-f16fic_@6yyi-t..Cir <br /> amwm.._._„ BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ..t ick,u(1"'hCc.A Contract Price of Work:$, 1l-CA') — <br /> Proposed Useilding: .Q< �?, , ...1 Heat Source: EGas Electric DOlher _ _ <br /> Building Type: FR-Detached DSFR•Attached ClDuplex DMuII1-Family-#of Units: ❑Commercial 0 industrial <br /> Type of Project: ONew DAddition DRemodel DRepair DT.I. DSign ElSprinkler DDemolition CIChange of Use <br /> DESCRIPT ON OF WORK: <br /> mall s1--- gpitt , I Eieci-- 6 //(-)AlLie°6/r,r7S) <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 _Reye pp/Jj <br /> 5. <br /> #of List o/Fixtures #of #of #of �'YL <br /> Fixtures Fixtures List of Fixtures List of Fixtures List of Fixtu <br /> Fixtures Fixtures <br /> A/C--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 f Water Heater Other; •Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> • SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads • <br /> ACKNOWLEDGEMENT:1 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 d a permit only authorizes approved work end no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.lam the owner,orf am authorized by the owner of this property to perform the work for which application Is made. <br /> and I comply with the Stale Contractors Law 18.2?ROW end 290.200A WAC. <br /> l ----- ' ' j City of Everett Official Use Only <br /> t (�' '-- - ' ' .d .41q tO `' Q PERMIT <br /> l�~G�ir i IM\0 02 0 <br /> DiKertAtithorized Agent Signature Date <br /> (Revised 5/20/2018) <br />