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(47-7- PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: z I r Li 5.Pl tAA etL L1J PROPERTY TAX#:' L>rJ-cicea.i aoii <br /> LEGAL for new construction: Short Plat/subdivision •J Lot No. (attach copy of long legal description) <br /> i <br /> CONTACT INFORMATION <br /> OWNER NAME: 1 nu' r..,c�1,a.. .,1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1561 GI >e&[(& ) 1/66W <br /> \ 'e?-7 - <br /> CITY STATE A( ZIP 9p, �d0 2'Z <br /> _OWNER PHONE: ((VS ) a j-35-Sti OWNER EMAIL: ({;&b ,(It(tint3.(\ cg1 �1(`,(\(,int.(,t, <br /> CONTRACTOR NAME: <1,(1,-),\'s fri.e.( 1-j I A L <br /> CONTRACTOR ADDRESS: Li STREET d ,J 3 nL'18 9 3 J r "!`, L%j(42 <br /> LAI AI a 1,,.J0L STATE ZIP --.— .__ <br /> CONTRACTOR PHONE: l ') ?;--y---;-c tis CONTRACTOR EMAIL: Y i)1(,( l a Y CJ [/L IA 3I/ 'EL; cow,-ir <br /> CONTRACTOR LICENSE#(REQUIRED):K)1,173�1lJt-1 '.}k- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (r't c %,O <br /> PRIMARY CONTACT: 0 OWNER clij CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (Gt " -31-2)_ 1-161 .) <br /> C{+5 knot Al CONTACT EMAIL: W <br /> IBUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ 2J1, <br /> .---)1:'1 <br /> 7' rJ <br /> Proposed Use of Building: Heat Source: QGas 0 Electric ❑Other <br /> Building Type: ❑SFR-Detached C SFR-Attached 0 Duplex 0 Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New DAddition DRemodel gRepair ❑T.I. ❑Sign ❑Sprinkler 0 Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: - [ <br /> I, ✓)CI efIOLS I d, _. 1.i A Ir �I ILC . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): I <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 #of #of <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> I 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 I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with t State C tractors Law 18. 7R W and 296.200A WAC. <br /> r ki /lb <br /> City of Everett Official Use Only <br /> , f /ICI PE # �l V) r D62o <br /> Own r/A � L) I <br /> e uthorize Agent Signature Date (Revised 9/23/2016) <br />