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° iittimiT PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING /SIGN/SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue:or Black In 'Only Please) PROJECT SITE INFORMATION ,.- <br /> PROJECT SITE ADDRESS: It 5 Pine__ S+ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> . .,. CONTACT INFORMATION , , , - «,- <br /> OWNER NAME: HO/LA-110k (I{y1.67Mki TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET // /v07.?/ ct,i 0 -/i 'C._ <br /> CITY "I// 0 flie-// ilitt <br /> Q�� <br /> STATE (/�A ZIP 470226, <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: f f 2t4 / Mil i/r7 'W /, cov A <br /> - '0 P <br /> CONTRACTOR ADDRESS: sTREEr(, /i/VZ7# CO411F,-6/761-(-- <br /> CITY /V4^,� STATE MI ZIP CJ ZZZ7 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR IkOTHER(Please Specify) t itj "rl/ / <br /> CONTACT NAME: CONTACT PHONE: LZo i)4-54 - 475-7 <br /> bA Y/17 MU `t CONTACT EMAIL: ine2f e",7/-,9 Vn ..„, <br /> , - i-,- ,.. , - <br /> ' <br /> BUILDING PERMIT APPLIcATION <: ,. ,. <br /> Existing Use of Building: 11-1)7F-1- Contract Price of Work:$ ii0 t 000 <br /> Proposed Use of Building: 7-ec.— Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Units: Commercial ❑Industrial <br /> Type of Project: El New ❑Addition ❑Remodel El Repair ❑T.I. ❑Sign ❑SprinklerDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: u� INn-I2 /761/ <br /> t-oz F-NdVftl7°1 2 Ptili5 Gro/ '1 P Pooh <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 Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number 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 /> Bui/di • 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 • V pl with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ICiity_of Everett Official Use Only <br /> ,0(26/ 0/� PERMI I YJ 10- <br /> Ow 1r/Authorized Agent Signature te (Revised 5/20/2016) <br /> eli2- <br />