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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> 1/1 -#6.•';'/:—A.-- CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: t1121 <br /> UV�1 l�� il� �'v 7DV�h PROPERTY TAX#: �-�, <br /> LEGAL for new construction: Short PlaUsubdivision u Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:)O e l .`l 1€ . G )- Kok .reNANT NAME(If Commercial): ?EC v <br /> OWNER MAILING ADDRES : STREET t V <br /> �'1 '/J� nt DY 2 . <br /> /�� Cmp"v �, Y,t lies <br /> 11\t/'t— LF q[(l X <br /> OWNER PHONE: /U�I. 0 IZ� 51l p //P�� !OWNER EMAIL:(Ansi. Yes Swl g ( b GV ' 01:9 <br /> U <br /> CONTRACTOR NAME: TBP C/40171, (" v\)'r/V\C, V� <br /> CONTRACTOR ADDRESS: STREET <br /> CRY STATE IJP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: 1 Z--etil 1-44 <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT B SINESS LICENSE#(REQUIRED): ]1[114 <br /> PRIMARY CONTACT: 0 OWNER ID CONTRACTOR CONTRACTOR OTHER(Please Specify) cony. •ttr7 .T <br /> CONTACT NAME: n CONTACT PHONE: 114. 1,5 3,'0 i 5 2 <br /> Val IAA 0 V�(X11 n S CONTACT EMAIL: D O w t n S@ I‘O MI O n S I . C O 1"1 _ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: r1 114•ti*Vitretil C. ttittiY 1Nontract Price of Work:$4000. 00 <br /> Proposed Use of Building: PO-M Heat Source: ❑Gas ❑Electric ['Other tY 1 1A <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: commercial 0 Industrial <br /> Type of Project: ❑New ❑Addition 1Q model ❑Repair` ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: `tin tv n "n (�� Pei <br /> I nS ' ` <br /> W Y V a(Jf \J e n --ht �xi ri 9 w i v I141 <br /> rtkok .n s-}-,, tin r) a N� /Wit �i Afi <br /> ived 4. <br /> ASSOCIATED BUILDING PERMIT#( applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New _ Addn Alteration Repair Type of Project: _New Addn _Alteration Repair <br /> Fixtures List of Fixtures Fbchrres List of Fixtures Fixtures List of Fixtures Fixtures List of 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 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 pemdt 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 tam authorized by the owner of this property to perform the work for which application is made, <br /> a,• -•, ply with the State Contra«• w 18.27 RCW and 298.200A WAC. <br /> Ilk i <br /> / QCiity of Everett Official <br /> all Use Only <br /> 2_3 <br /> 1 I 'O, b��2dl PE # .•.. V <br /> • er/Auth• e• •eft Signatu• Date (Revised 9/213`/2016 <br />