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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 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 4- `. rt Gtr s - Ave. Ever4.11- 7 e Q3 PROPERTY TAX#:004 3i P 00,1;>S o3 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Ke_ Yt €' 1 Car/Son TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5-4-(?`.), A /' <br /> cm, ( V.er4Z.j- STATE VL ZIP al t.L,3 <br /> OWNER PHONE: 3 O 3 4 is "/j 04. OWNER EMAIL: ( iase s`�Cckr-1 SO4.1 6) (IA et t .* (OM <br /> CONTRACTOR NAME: l'i GIL) �%1 <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: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: '� <br /> J � U �.� -7 lam- J <br /> i'1 E..� QA,Y~ I c 0�k CONTACT EMAIL: ((Er-t gi 64, exr-jso v t ) q L i/ co ell <br /> BUILDING PERMIT APPLICATION <br /> ExistingUse of Building: <br /> Al��A Contract Price of Work:$ 0 4 ej 6 q , <br /> Proposed Use of Building: C f;E>�G�S Heat Source: ['Gas ❑Electric ❑ ✓v sOther 3 <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial [Industrial <br /> Type of Project: UNew ❑Addition El Remodel ❑Repair DTA. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: g Otk_Il G�e et d <br /> iNkv <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 #°f 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 I SUPPRESSION SYSTEM <br /> Chemical or Water ' INo.of Heads <br /> ACKNOWLEDGEMENT.1 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 lam authorized by the owner of this property to perform 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 /> PERMIT# <br /> 0 R rq6—/ <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) (11/D <br />