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PERMIT APPLICATION <br /> 4BUILDING / MECHANICAL I PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICEST 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257=8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 30 1 /5 /.-6mjs j AveAye- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACTnINFORMATION <br /> (O <br /> OWNER NAME: Car( t pcv.1 <,e,n 1 C t,.f TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET .3n25' Lomb cry/ , ivd <br /> CITY I/t fe STATE W4 ZIP 7f 2." <br /> OWNER PHONE: L-I('L3 • ZS7- g1 C7 OWNER EMAIL: <br /> CONTRACTOR NAME: Je5fitr.\ )14echonre,r( CCS,`r lv 1 <br /> CONTRACTOR ADDRESS: STREET 70 le, �.9✓h, 2 Z o hi cfre.. 7 <br /> CITY .�F eSTATE 14 ZIP CiQ 05 G. <br /> CONTRACTOR PHONE: Z-5•3 .9 LP '.75-`i ti CONTRACTOR EMAIL: M4 1 wPsfe>^.,ivy L`fn• yr <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 1251585 <br /> PRIMARY CONTACT: 0 OWNER ial CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: /{ (� CONTACT PHONE: 25-5-Of'titj.9.S'y-i <br /> Mgt y°�1 I I, CONTACT EMAIL: j},'yy'-p Wisetee, mech. i'( <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: thio r a 4.¢Cr Contract Price of Work:$ 2,MP3(.D <br /> 1.1 <br /> Proposed Use of Building: $c vhq Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: )(Commercial El Industrial <br /> Type of Project: ❑New ❑Addition DRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> `LWT 1114enika-- . 4kwc4dv N cceKC II. 1. -fl.") <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 /> A/C—Air Handling Units Heat Pump Toilet J 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 J 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 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.I am the owner,or!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'i 4 4 . City of Everett Official Use Only <br /> 11-05 <br /> i PERMS \,_,-. (90Lek <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />