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i'llPPERMIT APPLICATION • <br /> BUILDING/ MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ��o 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 i(E)everetteps©everettwa.gov I wnrwr.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) SITE INFORMATION <br /> PROJECT SITE ADDRESS:48 a FdWLF.� ,A PROPERTY TAX#: a 1US 3 603(30 300 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:.3.050/YliAkiiratY SI OVCIK TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: sTREEr yea) Fent,1€4 AVE <br /> CITY EV Gg LI f STATE w"1-/� ,1`� ZIP gs'a0.? <br /> OWNER PHONE: 204 gtttg—75`34) OWNER EMAIL: sn(4j(,(, UI.I K a 7h da,com <br /> CONTRACTOR NAME: (DL)N ,L'- / <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ea 0 6, 9(--I ' 75 <br /> 1.)e.cz_ CONTACT EMAIL: ....10,0)�0i7adcSpte Yr4N00• CiZill _, <br /> 1 <br /> BUILDING INFORMATION O <br /> Existing Use of Building: RAS I DgNC� Sf I Contract Price of Work $ lky?0. 10 t 1).:--"'t- <br /> Proposed Use of Building: 12£S 034 NG 6._ _'`g Heat Source: OGas DElectric DO, er <br /> BUILDING USE: tat OTow:nhouse ❑Duplex DADU DMulti-Family-#Units: OCommercial •• - •r Str - - <br /> Type of Project: ❑New ❑Addition Bgemodel ❑Repair OT.I. OSign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> KE.Mt)I/E x.167,NG K lictif� eft-bs 0 i £ - uEt.Li /s1 insg� 7)U.! <br /> 1-041171 M) -- NEAJ 1A-16- cdI <br /> � �T'O{' iQ-h.r�.� t.1Z� .�A.,02 k v4:,(14-(%— ___ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Facturet List of Fixtures CountFixture <br /> Fb`t"re List of Fixtures Fixture <br /> aunt List of Fixtures Count <br /> Ust of Fixtures <br /> NC-Air Handling Units / Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler / Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless / Dishwasher / Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatio Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease WasteNVater Piping Repair <br /> / Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other. <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Medical Gas Water Valves or Fixtures <br /> _Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> Sewage Ejector or Sump Pump Other: <br /> ater Suppression System No.of Heads <br /> Chemical Suppression System 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 bein• -a,orized under any circumstance.I am the owner,or l am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply wit he S = •ntractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PER/417.) ck(e.m zo:... <br /> I: -..1 erno/9 it Juit.41,64, cf7/1 7 <br /> 0 , - iA . • •d Agent Signature Date (Revise 10/10/218 ) <br /> CT / <br /> -F <br />