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41ETT PERMIT APPLICATION <br /> BUILDING I 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 l(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) p. PROJECT/ SITE INFORMATION <br /> PROJECT SITE ADDRESS: '5711 'I�71V1, f fAik, (A PROPERTY TAX#: c 5)3500170O ct) <br /> LEGAL for new construction. Short Plat/subdivision Lot No (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: rte ANA %J-k (4-}v )c44 ) JTENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET g7 (f 251-14 � (� <br /> CITY ,�Y STATE Yj <br /> it J - ZIP t8 Zv3 <br /> OWNER PHONE: 751 3c53 -34E1 ] OWNER EMAIL: C—INLA KX 013 0E2:) .meq Cbl,a‘. <br /> CONTRACTOR NAME: 9&)KbYkTt(V,6- cz414 ( S I(S / 01.5 <br /> CONTRACTOR ADDRESS: ( STREET /4 sen___ <br /> 51j�� pp <br /> CITY ,14 A...)01/0‘944 ( <br /> STATE ,34- ZIP SINo3l.� <br /> CONTRACTOR PHONE: ZS— (p ( _ ZSZCO CONTRACTOR EMAIL: 10.0.( C_/kLA__ EA—F1-1., CO rot <br /> CONTRACTOR LICENSE#(REQUIRED): I IJIUPVCS 6cts T p WC <br /> � CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ,,/7610ce <br /> PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT�oNAME: C-10 <br /> ' 1 r l 'CONTACT PHONE: '16'7 -303 -� -l� 1 ( <br /> Kivviri- t C-00/J ) CONTACT EMAIL: tioft kn -,13 ls/�ft✓(Ctr�rLvr't <br /> BUILDING PERMIT APPLICATION U <br /> Existing Use of Building: Contract Price of Work: $ I/U�li c 'O <br /> Proposed Use of Building. Heat Source: EGas ❑Electric ❑Other <br /> Building Type: DSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel DRepair ❑T.I. Deign ❑Sp inkier ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: �dU <br /> �1� q <br /> �:� �} Cj <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 #of #of #of <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> I NC—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 /> 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 /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Chemical or Water 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 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 ircumstance.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 Cor actor aw 18.2 CW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT \‘.4 <br /> .r Z8— zvl / <br /> Owner/A thorized AgSi atu Date (Revised 9/23/2016) <br />