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PERMIT APPLICATIO <br /> /11.*0/1 <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 1 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: T1 i 23RD AVE. Mw, evege-t r PROPERTY TAX#: px,4-450 OO Ot 600 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: L V%a C./CM TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Lt-a( ?P'' AVE.. \'.1 E,vf 1E A ' i.5 t1 IPl <br /> CITY STATE ZIP <br /> OWNER PHONE: Cteje,. 01t}t C•C OWNEREMjC <br /> AIL: ?�(t( .{ y t Jy l4 �jwe(ISC�. DM <br /> CONTRACTOR NAME: eile V(E.\isi U( ,.. C 2 L <br /> CONTRACTOR ADDRESS: STREET (j - <br /> CITY 1� STATE /t/� (/� A ZIP <br /> p,� <br /> CONTRACTOR PHONE:(Zb )("600. l �j CONTRACTOR EMAIL: �OC 1. .(4'6 VO HAIL• `""-t <br /> CONTRACTOR LICENSE#(REQUIRED): rf^"k/TJtvigos"VN CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):�DZ'13 <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR RI OTHER(Please Specify) AR.C.Rcren.1-' <br /> CONTACT NAME: CONTACT PHONE: (+'�.�.) �g2►6i 2.1Mj <br /> 3k t F t CONTACT EMAIL: rt � u ccaotCAGz.6JE-C' <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: r--.E.SLnL�t. J($.. Contract Price of Work:$ 35, O Ex!'") <br /> Proposed Use of Building: e.t.a C 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 DAddition ❑Remodel DRepair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:p1:kmpt e EXLCOrt C9 j pOp 11,LF- . <br /> a *A4C°L tee. 4 .N.1CA `C' Al <br /> O 114 STALL. Sk LLC cca 1 t -:{gfeT <br /> o� <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 /> NC—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 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> cft,kPERMIT#De (Cl In Revised 9/2h (AOwn gent Ignature ate ( ) <br />