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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> '111P/40* '/74 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 www.everettwa.gov/permits <br /> (Blue or Black Ink:On y; <br /> PROJECT SITEINFORMATION ,E. E,„.... <br /> PROJECT SITE ADDRESS: 513I b W 11U►OI frj, PROPERTY TAX#: CC41SeOo3o(7o0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> m c„ ON,T,A O',T INFORMATION <br /> OWNER NAME: 0A-1--A21.3 6e4151.2 S <br /> CIN ' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 12722ZS"7l T, <br /> gui--EVVe STATE WA <br /> , ZIP qQoo <br /> OWNER PHONE: 4-Zs 66� � Z- OWNER EMAIL: �1.v�SE[ s eX✓GI\(/STS <br /> N <br /> CONTRACTOR NAME: S TT(.2 o V'c l,2t'(d(oN) Vt e <br /> CONTRACTOR ADDRESS: STREET oI .0, e 4-se 2 <br /> S .71:111. ; <br /> CITY c J STATE V VT'T ZIP g'z4 <br /> CONTRACTOR PHONE: 066 414 -9q--TG. CONTRACTOR EMAIL: glffrie cap A' 7 rx. '^ .. <br /> CONTRACTOR LICENSE#(REQUIRED): ���—`�Q V�s Ia t CI OF EVERETT BUSINESS LICENSE#(R QUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR tlSOTHER(Please Specify) Iext..1 wP <br /> CONTACT NAME: 2.:( I,,ONNI CONTACT PHONE: 425 2:79 .3('7 <br /> CONTACT EMAIL: Iwo Ko1NiN ,Xr1.11 <br /> BUILDING.PERMIT APPLICATION , , . <br /> Existing Use of Building: f - k 1 r(p-L Contract Price of WWor .$ ir <br /> Proposed Use of Building: Heat Source: Idea ❑Electric 00th- <br /> Building Type: 26R-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: •• mercial ❑Industrial <br /> Type of Project: ONew ®Addition ❑Remodel ItKepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: r epee p �, Mg ' 44,D visu c44,064.0 T0 au <br /> if' O4 ip IV "C[STf NG 4-Pppp'NG 31s tcz.r-'r <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECFIAN AL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: ANew _ Addn _Alteration _Repair Type of Project: w _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 3 Toilet Backflow Preventer(Inside Bldg) <br /> I Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler A- Lavatory(Wash Basin) Drinking Fountain <br /> I Water Heater Refrigeration Shower Floor Drain <br /> I Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> I Gas Range Ducting ( Dishwasher Roof Drains • <br /> ( Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> ( Range Hood �2ter� Other: <br /> Exhaust Fan 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 granti '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 unde :ny circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the Stat: Contractors -, 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> (2 /IV� 1'7 PE I #q( �-- <br /> V,Fner/Aut •rized Agent gnature Date (Revised 9/23/2016) <br />