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PERMIT APPLICATION <br /> BUILDING /MECHANICAL/PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OLT 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: j 0 4\0 Lv(;2Crl earNI %t A1/4f PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: j ct2Al,0 C.ZTV AT14Le TI CS TENANT NAME(If Commercial): 1[rile IaALO c zry Ptrii Lents <br /> OWNER MAILING ADDRESS: STREET IO(UO C�(;(L('jJM7�L L rAy <br /> CITY £VCRe rr STATE WA ZIP gip a �/ <br /> OWNER PHONE: ZS — 3417- ,. 0OQ OWNER EMAIL: <br /> CONTRACTOR NAME: =N FRA SOS)( .Cc S C R V L GC.`S L LC- <br /> CONTRACTOR ADDRESS: STREET / 4i/o 3 S rc,`v.j 4(LT 2 C) (j <br /> Cm- S,/V e/� STATE v f4L ZIP 78 S 30 <br /> CONTRACTOR PHONE: y 2S-3-f(, —(j g CONTRACTOR EMAIL:(J RL"y, elcekiNt I)(r-(C )?St',Cet <br /> CONTRACTOR LICENSE#(REQUIRED):T.4gr RA SL gl ( C,1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):051 9 0 <br /> PRIMARY CONTACT: 0 OWNER .'CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L2.5-- s`(, - --13 SS' <br /> A Lef A Lt 6 c.- 92 CONTACT EMAIL:Ob(Z.L� y l�L�X h .(‘ c{ p •C(1 i� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ It OO O. O <br /> Proposed Use of Building: Heat Source: das El Electric ❑Other <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 El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Re-t—oc-Ar icsif OF roMC-r 2 <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 Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> t 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 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 /> / JPERMIT# <br /> �ol��P� !� 0(e -09 <br /> Owner uthorized Agent Si. ature Date (Revised 9/23/2016) <br />