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PERMIT APPLICATION <br /> BUILDING / MECHANICAL I PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> '1111111 CITY OF EVERETT PERMIT SERVICES <br /> toiigi ' r 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)eieretteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:3S ►�tCK22 AVe. SF EVti.t-E},I,,IA 88201 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION I <br /> OWNER NAME: Evt ,Q44 C'oot OiS112 ck Corte NAME(If Commercial): Sii,V& kRCUA SQ. <br /> OWNER MAILING ADDRESS: STREET 3g0O (3tzoad,,rad <br /> E <br /> CITY /011—Q�k `J STATE In.)aQk ZIP c6 2_0( <br /> OWNER PHONE: 112$-3g5 Lt t't(o _ OWNER EMAIL: 51e12a1A$Q e .v2t22tkco( . 0I9 <br /> CONTRACTOR NAME. Tt3D <br /> CONTRACTOR ADDRESS: STREET • <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: • <br /> CONTRACTOR LICENSE#(REOUIRED). CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> ( "t <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR diOTHER(Please Specify) En9ine.e.2 <br /> CONTACT NAME: ELLISp LAM CONTACT PHONE: 2)6-3}$ - 0561 <br /> C512L*J AScl, soup CONTACT EMAIL: ett(sat @ q RQQ,nbU36,. C,o v <br /> A.A. BUILDING PERMIT APPLICATION 4� <br /> Existing Use of Building: GttACtti�ioAContract Price of Work: $ 883, 421 <br /> Proposed Use of Building: E Ca,Nr (1J- Heat Source: t3'Gas DElectric DOther <br /> Building Type: CI SFR-Detached DSFR-Attached 0 Duplex DMulti-Family-#of Units: D Commercial ❑Industrial <br /> Type of Project: ONew DAddition (Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Ztplact,ta t-( zit paolon *OA,✓QYL Gr,rt KVRC Con-h2o(5 ', Tn-khA:( 140 111114-4 "f,�I� <br /> C,00tli, -IOwQXt . YZuptate,v�c,�4 <br /> NtSRA.0, 010C sy sitr. , SI.Askxts , enol wtl one\ raup tau-INA' 4 QJ,CiSrt it'VA- 1,3 Matt/. ord CAtitltd wa-- <br /> CorY{►aot t✓V - `,r.,pmove Ws-1:".. eoot,w) }-6(422 sureo&1-. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION _ PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn 1f 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 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 I Cvotia3 To.tLtz. _ Water Heater Other: <br /> Exhaust Fan V 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 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 /> 4/........_:: <br /> ; City of Everett OfficialUse Only <br /> PERMIT#t- <br /> 02/2l/ Wig 1i 1\(651 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> .. <br />