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PE' - •LIGATION <br /> BUILDING/ MECHANICAL /SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EV= •ERMIT 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) PROJECT SITE,INFORMATION <br /> PROJECT SITE ADDRESS: /3 D I/ 90A sr S 1N PROPERTY TAX#: D O 392-2°00 0 t 9 0 2 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT:INFORMATION " <br /> OWNER NAME: c✓' Pi,&L/C SCh'o ot.S TENANT NAME(If Commercial): EN CE /26-5;12.4r2 dNrn , GO <br /> OWNER MAILING ADDRESS: STREET 39 O O —812z i W mac/ <br /> Q g <br /> CITY Edt/L6/7 / STATE WA ZIP 9 Z O.l <br /> OWNER PHONE: 4/2.S-'J3 SS -y/9Z— OWNER EMAIL: <br /> �/ <br /> CONTRACTOR NAME: aG.' T 66 9 "17EC/4-A1/CA- e-- <br /> CONTRACTOR ADDRESS: STREET /J/'UD SE �G• £'u/T6. /0 0 �J <br /> CITY 6446-1/LIE / <br /> 6� <br /> E STATE WA- ZIP 9 g O0 <br /> CONTRACTOR PHONE: Z1 '- 2Z2- 22 3 3 CONTRACTOR EMAIL: NNA N�f/O4m6Ei29Ca co tYJ <br /> CONTRACTOR LICENSE#(REQUIRED): 1/41/1/6'e 4/0(p to fYJ E CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): OSS o03 <br /> PRIMARY CONTACT: 0 OWNER $cONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 92„5--- X22 223,? <br /> NA-Al al sectoDs CONTACT EMAIL: /4/Aal/GG/S'(J 1l oLf Frz9 C o , CD f""7 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: El Gas DElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: El Commercial ❑Industrial <br /> Type of Project: El New ❑Addition ❑Remodel CI Repair CIT.!. ❑Sign El Sprinkler ❑Demolition CI Change of Use <br /> DESCRIPTION OF WORK: 3o6t1rj�Ll- 5?,Aste-S t4 OTI-1 0.4004.4/%4Z0 iFL001%-- lint- 50411EAJOVtil <br /> eKEWk5tA/5*04.4M R- Plws4.4.4sldtt IA;SUVrtzntl.! <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 I 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 I Floor Drain <br /> Gas Fireplace Wood Stove ✓/ Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting - Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: I Clothes Washer Medical Gas <br /> Range Hood I Water Heater I Other: Efl7 29 Hcy Wqs r/ <br /> Exhaust Fan I Sink(Service/Bar/Mop/etc.) ( Other: fLEF2il612.a.-mL <br /> SPRINKLER I 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.lam 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 <br /> Only <br /> A-411411111/1// <br /> -"� <br /> --745-Ag PER 7 ( ?0-7_6) CIfJ <br /> Owner/Authorize• • • Date (Revised 9/23/2016) <br />