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1 <br /> PERMIT APPLICATION■ <br /> '111.71.4 <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 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) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1224' rt te'hhiii•a f �vPROPERTY TAX#: O c 3 Ljy Q?IO1 0-0LEGAL for new construction: Short Plat/subdivision 11 Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: \-1\1(\\AVNVI [Wim` LL,C_ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET PO R,A)( 12-q I /� <br /> CITY Map(,Q1 l 2(Ce)1/41 STATE, c,,,/ <br /> nA�n( \n ZZIIP1 - j O lJ n i <br /> OWNER PHONE: 1�11�, �c 0g l! ��11��' OWNER EMAIL: (/�,1�1/�'a►�/1'i YQ' U i N o'U I l'" 6yywkii,om <br /> CONTRACTOR NAME: -1;),b1/\ RATA ...-7b -,:› li....re...k. Covd-r-A-eko-A93 <br /> CONTRACTOR ADDRESS: STREET ?O €Q')( id LIS- <br /> CITY <br /> lSCITY SNACM LA \ STATE w.Yt ZIP la 291 ) <br /> CONTRACTOR PHONE: Li.2-S - 1/2-- 3 C CONTRACTOR EMAIL: "/Q si/w ()) £ (4Sf . yiX <br /> tT <br /> CONTRACTOR LICENSE#(REQUIRED): P�a,C� D t 5 Z CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 11 {-C1 0 <br /> PRIMARY CONTACT: l:7`j OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: lj° es- �� • <br /> A Z CONTACT EMAIL: a1Dir1n l (gAsywo /�' (i,` <br /> BUILDING PERMIT APPLICATION U <br /> Existing Use of Building: Rob t fly, Contract Price of Work:$ SOU- 65 <br /> Proposed Use of Building: NiO ( \ar Heat Source: Lias ❑Electric ❑Other <br /> Building Type: tXSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project:tt((((❑New ❑Addition QRemodel `Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Mlwt IC• �bIQ � C <br /> t(n.B�‘k r.r'-t auk f a t low <br /> - 1h PUt1 (L t Ater Kvater Coto.ewmAr cl0 nck c'errin tt, " <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ?V't<WS—OW <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New % Addn _Alteration XRepair 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 /> i Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> I 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: FAO Clothes Washer Medical Gas <br /> Range Hood - I t ^r€ Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER 7 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 /> City of Everett Official Use Only <br /> • <br /> S /d <br /> I (b ZSI ` g PE W k ,`O _00 <br /> ' <br /> Owner/Authorized A;• t Signature Date (Revised 9/23/2016) <br />