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PERMIT APPLICATION <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 Iwww.everettwa.gov/permits <br /> Blue`:or Black I" k Onl` Please PROJECT Sl E INFORMATION <br /> PROJECT SITE ADDRESS: 6707 14,volcspr 4k/eve/d1; WA qgZ-03 PROPERTY TAX#:220 Lto t,00 Lit 1900 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> n CONTACT;INFOR1iilAT1"ON .-- -- <br /> OWNER NAME: Um b C,,SC-;1 014i iyIC Imo- � fl <br /> OWNER MAILING ADDRESS: STREET 6707 Oct{k50 1 Rl <br /> CITY evirt?fT STATE WA ZIP 9g26; <br /> OWNER PHONE: (y2)LOS-3 So0 OWNER EMAIL: <br /> CONTRACTOR NAME: Rol,l,,yhey�d. 1144,11('Q / <br /> ConCe,? j <br /> CONTRACTOR ADDRESS: ] STREET�)SOOv11 Wit '��U S t(1e. 101 <br /> CnY �Zt� � / / STATE WA r i ZIP(fig 00 <br /> CONTRACTOR PHONE: (253)333-2.1 CONTRACTOR EMAIL: kp, vyylG�t(�[44r 11✓v. :,Y✓l <br /> CONTRACTOR LICENSE#(REQUIRED) RP,ymvhc, 3.L'kb CITY OF EVERETT BUSINESS LICENSE#(REQUIRE' :43tf'3 $ <br /> PRIMARY CONTACT: 0 OWNER .CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: -CONTACT PHONE: (cO3)446-076( <br /> )d 1 VeJ CONTACT EMAIL: p e rfl JI v45,COYr) <br /> ",;.: .. ,: BUILDING'PERMIT APPLICATION ' . . . , <br /> Existing Use of Building:lnla✓efiet4.5-e aviA LI y4-1- anu{ac-1ac,ity Contract Price of Work:$ 1',y%O( <br /> Proposed Use of Building: P6,43 man rti{aL rl'y� ll Heat Source: 'Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial industrial <br /> Type of Project:jg'New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler CI Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 7-441S1-A-LL.- T-D l,.tcTe.6 VA — <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 /> NC-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 /> 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.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 /> `.-/ ��9� ��i'1 l 1 7 PERMIT <br /> �gl\1 ( _ /vhf r 2 ' <br /> ., .J \ <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />