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OLT 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: Y le 2.0 0,0,441k.Jt00r1. 4&l/rt c. PROPERTY TAX#: ®®tel'pp gi'337)6 <br /> LEGAL for new construction: Short Plat/subdivision 14 ADS,H0fit51 Lot No.!. %(attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 51)5Rai, gat WjArlEIL Beift4 ,kkc TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (,,to 20 Cbrvkrula,dic,tett- kik SIS. <br /> CITY cVIZ a 457 STATE ZIP Ot t)2401 <br /> OWNER PHONE: ,- ' 4 OWNER EMAIL: <br /> CONTRACTOR NAM �,.. NJ"4 (X4, m1_ C <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 MOTHER(Please Specify) 7kdLGEI tPISC.T. <br /> CONTACT NAME: CONTACT PHONE:kis• 31.4• t 34 <br /> 11&lt.1141 T,E VA R?e k<tk CONTACT EMAIL: onr znvipes codlCri Q,r.L►te c.tuf �• 1410,. <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: C3 _&t.a fpwytt,,41 jes4,. Contract Price of Work: $ 'r5 S ,/`,. <br /> Proposed Use of Building: V u f ,,E,,i, Heat Source: ❑Gas Electric ❑Other <br /> Building Type: ❑SFR-Detached ESFR-Attached ❑Duplex ❑Multi-Family-#of Units: ECommercial ❑Industrial <br /> Type of Project: DNew Ntinkddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Nisw &KA*ettld'l kkeDV1 j1®NI TO Y,X.tSIVAR STK • <br /> s <br /> • �3 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): Jam_} PE ,ems(, ‘, <br /> C� <br /> MECHANICAL PERMIT APPLICATION PLUMBING RMIT 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 tea, Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler A. Lavatory(Wash Basin) Drinking Fountain <br /> 4 Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove I Kitchen Sink& Disposal Grease Trap <br /> Gas Range Ducting f Dishwasher Roof Drains <br /> • Clothes Dryer Hookups Other: t Clothes Washer _ Medical Gas <br /> i Range Hood Water Heater Other: <br /> Pe Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> 'Chemical or Water I INo. 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ...,.,„).? ,/ r'-;-"T"- .;,j,1;:5- eb_c11-2t,kPERMIT# <br /> Owne Lthorized Agent Signature Date (Revised 9/23/2016) <br />