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PERMIT APPLICATION <br /> °141.1:111P/44 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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) JPROJECTC1SITE INFORMATION <br /> PROJECT SITE ADDRESS: 17 t & �r 1 V9' ;` PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: kVA daa.‘, 7-\ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET f 103 gvi1r ( <br /> am/ <br /> CITY ej(f`� STATE tAra ZIP°Ieg2e)' <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; PM" Pt VVYV 6 1/ I "lAll <br /> CONTRACTOR ADDRESS: STREET Jll, I V i sl tatvI4,t,. ay-e. <br /> ITY ? - / STATE ZIP <br /> CONTRACTOR PHONE: v ITurl <br /> xi in � IV"" 0 ' 77 CONTRACTOR EMAIL•/ I R 1 Oi ,l6 gyral) IVY t <br /> CONTRACTOR LICENSE#(REQUIRED):( ' e (( I t� CITY OF EVERE BUSINESS LIC E#(REQUIRED):05r <br /> . y/ <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (tt ?1 <br /> W-16 ) 3 I CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ '2.11DLc D9.-..... <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: )'ovl/ {Ai <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 /> 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 t Other: '-i r ' 0 / <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) , Other: , , / ,` h f Ili <br /> IVI <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, -te,and local law he granting of •-ran o • -. •• 'zes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Offi -I be ore bein. -•horiz:d under any circumstance.I am the o -,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comp/, with the St- -Contract.s Law 18.2 RCW and 296.200A WAC. <br /> l 1 l�a City of Everett OfficialryUse Only <br /> / .gl )q 1/Nl . PERMI,1..'piO�q U o <br /> Owner/Au ge Signa re ' , Date (Revised 9/23/2016) <br />