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- PERMIT APPLICATIC:: <br /> BUILDING / MECHANICAL I PLUMBING /SIGN I SPRINKLER I DEMOLITION <br /> rW-/ -°"-A <br /> CITY OF EVERETT PERMIT SERVICES <br /> %A.dW- <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 l FAX 425-257-8857 l(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> ii PROJECT SITE'INFORMATION ;: <br /> 1 . .. <br /> PROJECT SITE p, ESS: <br /> PROPERTY TAX#: <br /> U-c5t PD4c-ART2€ T <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ;CONTACT INFORMATIION <br /> OWNER NAME: v.Eit iT SGfioot. 1,157 RI e-T dl Z• TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET S100 13r00AW011 <br /> -<i�Tr EVeG'eil' <br /> STATE VA ZIP "I67.01 <br /> OWNER PHONE: irOWNER EMAIL: <br /> CONTRACTOR NAM : 11104 C S 4nj'e a ` <br /> CONTRACTOR ADD SS: S EET <br /> \ CITY STATE ZIP <br /> \ \ <br /> CONTRACTOR PHONE:' CONTRACTOR EMAIL: \\t <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)' Un *4A Lc <br /> . <br /> PRIMARY CONTACT: O OWNER D CONTRACTOR (OTHER(Please Specify) P cGlni fe . <br /> CONTACT NAME: CONTACT PHONE: 4 ZS_r•ZS-1 —c %(,4 <br /> LhtiS Kaef <br /> CONTACT EMAIL: GH 6-4.ra.e.c ,e,by w c-L. .Lc. <br /> ' = BU,ILDINGPERMIT APPLICATION. .' <br /> Existing Use of Building: S Cafll Contract Price of Work:$ DISI ST c <br /> Proposed Use of Building: S C-A4 Do` Heat Source: ❑Gas DElectric DOther <br /> Building Type: ❑SFR-Detached O\SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ONew ElAddition 'aGlRemodel DRepair Ict.I. DSign OSprinkler @Demolition OChange of Use <br /> DESCRIPTION OF WORK: to �y�-� Vey};bUle• A2� Ne'^/ c�`I' mor ash o <br /> Aa.dlkrir air r. rias llwall 'fa Gieak ��"'v `� <br /> CAfeir,t a0.• IZeIL,c.,...4e' ✓eALMp AGL.f,5 4.6 e3(15•4: S' •2 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> `MECHANICAL PERMIT APPLICATION:: ;; <br /> PLUMBING PERMIT APPLICATION. <br /> _i — — <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 #°f List of Fixtures <br /> Fixtures Fixtures 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 Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> �SPRIINKLER I SUPPRESSION SYSTEM; <br /> Number 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 1 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 WAG. <br /> City of Everett Official Use Only <br /> ----1-‘': <br /> PERMIT# n Fi �� 061 <br /> Owner/Authorized Agent Sign Lure ate (Revised 10/12/2015) 7ii <br /> 1 <br /> IZ <br />