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PERMIT APPLICATION <br /> ee*:/4"----g. 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION�� <br /> PROJECT SITE ADDRESS:�paj II d )E r ,WA/ &`Oc.PROPERTY TAX Menacarkrik21500 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: KO koerne P 1.-`O(neS TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 7e/g6 s E 9,7411 54 a <br /> r1 t CITY rn^�r ' c ��j STATE ( ZIP? o co <br /> OWNER PHONE:(las-a�t�t-c,64.6, J'O^^W"NNEE���R EMAIL:C�o�Dros3\1 g ;1 •Corr <br /> CONTRACTOR NAME: qs Y>te4 `� cv4,$eS L_'Lc' <br /> CONTRACTOR ADDRESS: STREET?.O. O AS� . •__ . _ ..Cn- Nm 4 L STATE w A ZIP?an 2� <br /> CONTRACTOR PHONE: 4DS-a46 k Cp(p ah CONTRACTOR EMAIL:CNNoct gPC(YSe,11 )%orvic,t. CQ m , <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER g8(CONTRACTOR 0 OTHER(Please Specify) � <br /> CONTACT NAME: CO G e_c.w $i\ CONTACT PHONE: '11'‘P'S''' aGt>' 1„ 6^6 <br /> v CONTACT EMAIL:0�mA n eO(b(Q,II�)Gina s I t co(Y1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: MOY'P Se/e. Contract Price of Work:$ an (-3,00 . <br /> Proposed Use of Building: a-�jry�,Q ,S/%�',,, Heat Source: ❑Gas Electric ❑Other <br /> Buildin• T pe: ❑SFR-Detached ❑SFR-Attached ❑Duplex t Multi-Famil 4 of Units: ' ❑Commercial ❑Industrial <br /> Type of Project: El New ❑Addition ❑Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition CI Change of Use <br /> DESCRIPTION OF WORK:Z.�,S\cca,\�o t .w � <br /> INNOs,(• faCANA•Qc) N\00/ ...% h� �O q 'E`.153cI S T k 1. <br /> S\ONe. Vt\;i- 40 Ce-Vaee. CA6`clorne, %oe Na tvnooe ci oc.94 (Aro 4.4. ;4Wr;rt u4.;4:4;e_� <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 #°f 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 I <br /> Range Hood Water Heater Other: jjant Vt00# <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) ` Other: gory <br /> SPRINKLER l SUPPRESSION SYSTEM <br /> Chemical or Water ' INo.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.1 am the owner,or I am authorized by the owner of this property to perforin 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 /> PER T# <br /> � ra^ Zy��� F1 1 el DIS <br /> Owner/Adthorized en ign� Date (Revised 9/23/2016) <br /> 47tot.f- Poe Ow,.t er0 <br />