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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> "111414% ------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 frr ,, i i 1,7 :` <br /> PROJECT SITE ADDRESS: 31 0 5 ',hi Si'. PROPERTY TAX#:QitI 3£ D 7Se 1 Da <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> 'CONTACT INFORMATION , <br /> OWNER NAME: Pt(\e Siree+ tici-f-QhL TENANT NAME(If Commercial): OP��-4 j4-�I <br /> OWNER MAILING ADDRESS: STREET I I CI N„ ( �-erti tilat,i SiSF , , I(v'5 <br /> CITY 13I t)/4 h a t STATE w it ZIP qg Z2 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Mater S I girt <br /> &Aryan,Li <br /> CONTRACTOR ADDRESS: STREET k Y - _ I q c. s4 gd <br /> , <br /> CITY Kt(A-M.t V"ef)i GPt t STATE/ ZIP V .a-73 <br /> CONTRACTOR PHONE: 300--1 -gs t f-a•VVV <br /> 2)-(- 1 3 CONTRACTOR EMAIL: Si���'; q <br /> e&(eJai 4v), 6641 <br /> CONTRACTOR LICENSE#(REQUIRED): (`.'t C1/44I✓R._$G $2)23k CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER ArCONTRACTOR 0 OTHER(Please Specify) <br /> C TACT NAME: C CONTACT PHONE: 5tt(� -ti 214- (3,9-S3 All i L Glad 4,L O CONTACT EMAIL: Ste-ran)f rw/,. .e_rs i q v eon-, <br /> < ' ; ', <br /> &-- <br /> ,. _ BUILDING PERMIT APPLICATION <br /> Existing Use of Building: -)k,\ Contract Price of Work:$ 0/'000- 7C) <br /> Proposed Use of Building: kAl}i,-(,k, Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial CI Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair DTA. Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1y,‘5}_a (t rvi 3 I tul Ml,I\Q}_c(L wGlu( S i of vl.s a^cf Z M e✓twivvtvo t <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 /> 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 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.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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> �� —11 ICC #S \��3 �0 <br /> ner Authorized Agent gnature ate (Revised PERMIT 9/23/2016) <br />