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PERMIT r PPLICATION <br /> 4111lii4::::1 <br /> BUILDING / MECHANICAL/ PLUM;INO /SIGN /SPRINKLER/ Li EMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> % __ 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov( www.everettwa.gov/permits <br /> (Bh a or Mack Ink Only Please) Ph OJJECT SITE INP MATS " <br /> PROJECT SITE ADDRESS: 7404- vimrte- i/ J1ir1---i' /- PROPERTY TAX#: CO 2' 1 90,9/of <br /> LEGAL for new construction: Short Plat/subdivision _ ��/ j Lot No. (attach copy of long legal description) 1 <br /> C•NTACT INF`0 RMATION <br /> OWNER NAME: CA" CIA/0 lCe tlepl4t4 Cemj-„Q/ TFm�nnir KT <br /> OWNER MAILING ADDRESS: STREETa .` (2--t OT 4-' <br /> CITY M,,1 Oic—eE STATE v.J ZIP ' di <br /> PHONE: OWNER EMAIL: ��V// <br /> CONTRACTOR NAME: 'S`T JA I.laeVS' <br /> CONTRACTOR ADDRESS: STREET 2.142.G12.142.G1J Al* <br /> CINi "Dl" [)IQ%), STATE V) k- ZIP 4q,,O C <br /> CONTRACTOR PHONE: 2@6- '2, CONTRACTOR EMAIL: du1 IAq c.0 2',�- 4} , I, <br /> CONTRACTOR LICENSE#(REQUIRED):_.� tib 44!�` 51.,.( ' CITY OF EVERETT BUSINESS LICENSE#(REQU -ED): 3' <br /> PRIMARY CONTACT: ❑OWNER VCONTRACTOR 0 OTHER(Please Specify)* LJd2 -5 546 <br /> CONTACT NAME: CONTACT PHONE: ( ?) i-- (0 f <br /> �Gt j ,`f �l Ni CONTACT EMAIL: d I�(I W1 $9`Z,q'" `u' U�C�o(+GP/,.,` <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: \ Contract Price of Wor $ 4 t°29---. <br /> Proposed Use of Building:C_Nhkt role a‘-ice a ce Heat Source: )L(Gas ❑Electric ■e er <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1 . ki00 0 ��vat 0.i <br /> 76#144) few 0A,Ii( of Otcf c- - <br /> • <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/SUPPRESSION SYSTEM <br /> Chemical or Water 1 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 lam authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the Sta a Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> L �"t 26l g PERM( k?O� O <br /> r2.5 <br /> Owner/A thoriz Agent Signature `Date' (Revised 9/23/2016) <br /> Ql...1_, <br />