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PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN I SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OLT 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) PR/OJEECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2 / <br /> /1 7 C-0 144 �rd Ave._ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: F1''(,4 oK La to Ief� / TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ,2,`/// pL47,-o6 d A ve /J/� / <br /> // CITY .1 V e/l�[�lj- STATE �/4 ZIP 9820/ <br /> OWNER PHONE: (:/:2.Z5) 120----4757 y' OWNER EMAIL: <br /> CONTRACTOR NAME: G.7 r�J Ie,S Ora 77 orl / c <br /> CONTRACTOR ADDRESS: STR>`ET /9 T ` 14 "Xte:59-2q,9. <br /> CITY j v-ere STATE/:- <br /> v 1 ZIP %f2 6 <br /> CONTRACTOR PHONE: *0 g06 ^ : r •NTRACTOR EMAIL: PGZU/' VQ.S7I (/,6e.-�y --,-.�,o14 <br /> CONTRACTOR LICENSE ' : 0 UIRED): � i Q,,Q ` $3�r :P TY OF EVERETT BUSINESS LIC NSE#(REQ D)eltkee e <br /> PRIMARY CONTACT: ■ : _e _ e- - : R(Please Specify) <br /> CCT NAME' � <br /> : � C � � <br /> ILO `� JONTACT PHONE:( 96) 096' -- 86 S y '�" ' —"' <br /> � Vr / 1,52t� �� CONTACT EMAIL: pc(;GL/ vas/ •, / ed0 71-7 . <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: % WS//e$M/ Contract Price of Wor 3/006) <br /> Proposed Use of Building: Heat Source: [X(Ga. ❑Electric 00th <br /> Building Type: eSFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Co.• ercial ❑Industrial <br /> Type of Project ❑New ❑Addition ❑Remodel ❑T.I. ❑Sign ❑Sprinkler ="'-- on ❑Change of Use <br /> DESCRIPTION OF WORK: / 1 /� <br /> hi Ter -ol 'Ob 7`zro a, dam/ E,, <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 _Repai • <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of Li.-. Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat mp Toilet B.- ow Preventer(Inside Bldg) <br /> Forced Air Systems it Heater Bathtub rinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Dispo,- Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hoo ps Other: Clothes Was,-r Medical Gas <br /> Range Hood Water H- er Other: <br /> Exhaust Fan Sink --rvice/Bar/Mop/etc.) Other: <br /> SPRINK R/SUPPRESSION SYSTEM <br /> Chemical or Water I 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.1 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 the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> I _, / / City of Everett Official Use Onlyly�2 <br /> gl,‘/VG5I/ Gf — /l3/�� PERMIT#���1 LA *. L/` , <br /> Owner/Authorized Agent Si ature Date (Revised 9/23/2016) <br />