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PERMIT APPLICATION <br /> BUILDING/ Mi Ci EANICAL/ PLUMBING / SIGN 1 SPRINKLER I DEMOLITION <br /> CITY OF[VER 11 Pt Pl..:Tlkill SERVICES <br /> S <br /> 3200 CEDAR STREET,EVt I1I 1 l,WA 98201 <br /> (P)425 57-€3tti0 I AX 425 2..174195/ l(E)everettep5(we.,verettwa.gov I wwww€.vE retlwa.govfpointit:: <br /> r pr ;: c t t everottens@everettwa.gov <br /> (Blue or Black Ink Only Please) i,D•7)4' PROJECT SITE INFORMATION <br /> PROJECT 511E A[)DIU ,S 3063 W. CA ho +r. <br /> r+ ©( EvcrtkA a <br /> (t 10 ct'xo3 'PROPERTY TAX#: <br /> LEGAL Se new cut struat[on: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (3OC r*'1 TENANT NAME(If Commercial): oet <br /> OWNER MAILING ADDRESS ;�=e ei 'Soo' tr-t C,.ta.S R,Nra 1Qt..' Iv�t n.. ,...�...._�° -214 <br /> Coy E.tfeve,t4 SIAM. OA ZIP , C ti 2-63 <br /> • <br /> OWNER PHONE: '125-"dab-toll-. OWNER EMAIL: iVtekrr wre{", t r‘A.(s44,eirtt. e *wad ,co t <br /> CONTRACTOR On N1tGk4hiCAat C.aA-y*4+1 a tvtt,. <br /> CONTRACTOR ADDRESS: sTRcci I t t>a It LAI4%, T t&C(. (,J(,tk <br /> CITY 1J1 V.,k`t I At() STATE IJ A .....__..__..... zip ,1512-15 . . ,.W <br /> CONTRACTOR PHONE: 253 -610.9 0&'O CONTRACTOR EMAIL: ;p rt,t a 4 c .l t,,(Ai e umc,i . coo-% <br /> CONTRACTOR LICENSE fl(REQUIRED): k'UN IVMC"'',�13N i CITY OF EVERETT BUSINESS LICENSEft(REQUIRED): (n21:2.7 Z <br /> PRIMARY CONTACT: °OWNER Ni CONTRACTOR U OTHER(Please Specify) ._.__. ... <br /> CONTACT NAME: CONTACT PHONE: 25- —(.070... O o <br /> t,A4, cA c (I CONTACT EMAIL: to +-_ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Buildingbail, eue Contract Price of Work:$ 10 t Ot) <br /> Proposed Use of Building: tO& i roa«, re.+wo et.4,.t Heat Source: °Gas D Electric 0Other <br /> building Type: ❑SFR-Detached DSFR-Attached °Duplex °Multi-Earllly-0 of Units:___ CICommercial WIIndustrial <br /> type of Pro'ect. °New °Additian 9.4Remodel °Repair DTI. °Sion °Sprinkler DDenaolition [Change of Use <br /> DESCRIPTION OF WORK: <br /> Ram 040 tt ek I00.:' voop a t-a i r t.ut i)01.hrt S , <br /> ASSOCIATED BUILDING PERMIT#(if applicable); <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Protect. New Addn Alteration __.Repair 1 ype of Project: _New Addn Alteration • Repair <br /> Fixtures List of Fixtures Fixturesf Lisf of F fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> A_/ -AIr Handlin Units Heat Pump dr. Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub — _Urinal <br /> Gas Ppinq Boiler Lavatoy(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 Ilookup <br /> s Other, Clothes Washer Medical Gas <br /> _..._Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mopietc.)I __.._ Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No,of Heads <br /> s <br /> ACKNOWLEDGEMENT'I have reerewed this application and continn the information cdntakeed herein is true and correct,Work done pursuant to this permit crust comply with <br /> ctment federal,state,and loorif how. The granting of a permit only aulhnnzen approved rm rk and no deviations therefrom (Deviations must first be authorized in writing horn the <br /> tinkling Official betow being authorized under eny circumstance,I am tire Owl or f am arrlharized by the owner of this property to perform Etre Work for which application is made, <br /> and t comply with the State Gontrawlors Law 18.27 PEW end 299 200A WAG <br /> Cityof Everett Official Use Only <br /> PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 0723/2016) <br />