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416-77- PERMIT APPLICATIO <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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE pINFORMATION <br /> PROJECT SITE ADDRESS:310Qt�+ fisc. 0IV� Oeleif I o.„2O ) PROPERTY TAX#:OL) 20(0 ),...- J( -j 6 e' <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> 1 CONTACT INFORMATION <br /> OWNER NAME: (M'`qt'lc S•1-1. c TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3 10 ,1Q 1,.,� 8 t <br /> i9;c /8 <br /> CITY £ 14 t/ie STATE `:\ ZIP GI?R 03 <br /> OWNER PHONE: yet, 311 5021 7 Q'` OWNER EMAIL: o o4fA g KO4-a \ <br /> l,I •COW <br /> CONTRACTOR NAME: A boC\e- C_.O r'Aek; A. J c.. <br /> CONTRACTOR ADDRESS: STREETS N 0LI 1.M i L ,6 <br /> CITY I~-,/e ce{-It STATE 164,14'... ZIP c 32o 3 <br /> CONTRACTOR PHONE: L./AS-3 tR (g Rt7 CONTRACTOR EMAIL:OII9UaeCp✓l-1Lracf /.."6:7 r-61Nt •COM <br /> CONTRACTOR LICENSE#(REQUIRED):IADO OE C I q 3 1._5 W CITY OF EVERETT BUSINESS LICENSE#(R ,EQUIRED):o c,r <br /> PRIMARY CONTACT: e1 O#(WNER 0 CONTRACTOR 0 OTHER(Please Specify) ((�� <br /> CONTACT NAME: `(� CONTACT PHONE: t{2S- 3 )G gal 7 <br /> iM. k �J mcL- CONTACT EMAIL: ail vt C.6v`Cf•TG•C+:JK ®Isp-r'iw, t.c0.4,BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 7‘v1)`..4," �cyvr1.� Kr jt -t C c% Contract Price of Work: $ <br /> Proposed Use of Building: ' ‘\,(V GcvrlAs---. St ' N-P Heat Source: 'ErGas `BElectric ❑Other <br /> Building Type: GSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New aAdhe/dition ElRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Aci8 q add ;+;vv\ - 2xpatG I .14k.keA + Mas-vee- bah ir <br /> -ex:s4;r•5 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn Pk, Alteration _Repair Type of Project: _New ! 'tddn 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 74 Heat Pump 1, a_ Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater �( Bathtub Urinal <br /> ), Gas Piping Boiler lA Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration 1 Shower Floor Drain <br /> I Gas Fireplace Wood Stove ,'„ Kitchen Sink&Disposal Grease Trap <br /> iI Gas Range DuctingDishwasher Roof Drains <br /> Clothes Dryer Hookups Other: / Clothes Washer Medical Gas <br /> 1 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-.. oriz•d 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 Sontr.•or.- aw 18.27 RCW and 296.200A WA C. <br /> /tat1C ( % City of Everett Official Use Only <br /> /17'/' <br /> /`qPERMIT( \ 1 D . —�Ith. ¢e. Ag- Signature Date (Revised 9/23/2016) <br /> 2 <br /> i2 <br />