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PERMIT APPLICATION <br /> BUILDING IMECHANICAL/ 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 INFORMATION <br /> PROJECT SITE ADDRESS: "1 LlAVI £"c, ,v4 4(41ROPERTY TAX#: 001414 CI1O(1)00 c'®6 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:De e;SU-, kvG hi TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET -4 -52_yl., eje c' A V, <br /> CITY ✓'O-t! - , STATE 1/../...4 ZIP I cr2o <br /> OWNER PHONE: 4'.s" qi-[c N c(6-1- OWNER EMAIL: eVUk 4,Cl.toe IOK e/lif/+wrdti I.(vim <br /> CONTRACTOR NAME: 6 It i& oil vl <br /> CONTRACTOR ADDRESS: STREET yr-101 1 �j ,CI - 4_ t/� 54' <br /> CITY h 1/-ts•c4p4'.` STATE Xi VA--- ZIP [1,'�G� <br /> CONTRACTOR PHONE: If?4" f u( *- I S / CONTRACTOR EMAIL: 72S <br /> CONTRACTOR LICENSE#(REQUIRED): GLEN D *O$a JA CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):55 p9' <br /> PRIMARY CONTACT: 0 OWNER irCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Li z,r- 5-0 1 --1 C 3 / <br /> boolto avv CONTACT EMAIL: <br /> / BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Ccs e Pci*''t Slte D' Contract Price of Work:$ I 57// 076,d <br /> Proposed Use of Building: k,,,,, '-/ D4 (4 7 Heat Source: Gas DElectric ❑Other <br /> Building Type: J SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: Wew DAddition DRemodel DRepair ❑T.1. ❑Sign OSprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: j,{ G� <br /> C GQ✓ 5 etNe t ;n,. ' k-1 (Z S1 P A R pwarc,,,,,,� ,t/- 'l 10 G✓-e <br /> ASSOCIATED BUILDING PERMIT#(if applicable): V <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: ?New Addn Alteration _Repair Type of Project: K New _Addn Alteration Repair <br /> #of #of List of Fixtures List of Fixtures #°{ List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units Heat Pump I Toilet -6<*SE..t Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater ' Bathtub Urinal <br /> 2 Gas Piping Boiler j Lavatory(Wash Basin) Drinking Fountain <br /> j Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove 1 Kitchen Sink&Disposal Grease Trap <br /> Gas Range C Ducting I Dishwasher Roof Drains <br /> 1 Clothes Dryer Hookups Other: I Clothes Washer Medical Gas <br /> ) Range Hood / Water Heater Q Other: tOg.,& 44t.dC L.4S4.6 <br /> 2 Exhaust Fan 1 Sink(Service/Bar/Mop/etc.) Other: rif <br /> /t) atiti) <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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ..----'-) <br /> (( PERMIT(#Q <br /> Owr- Authori -, -•ent Signature Date (Revised 9/23/2016) <br />