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PERMIT APPLICATION■ <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> • Oren- 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 INFORMATIONn <br /> PROJECT SITE ADDRESS: 33 2-74' '110Ave., FIL4, 9'92 6 41-J PROPERTY TAX#: 0 6 l(3`?,del 666 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 33 2 3 .40y t A✓-e—. (--4- 4 t TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET l I res/I Li(j . pt. I�QP� r� /� <br /> CITY L yh Ivo,oi STATE 1V. ZIP 9/637 <br /> OWNER PHONE: 2 G 6,- "2-ii" -"3701 OWNER EMAIL: Ccdh qh, ,at 9/5'0 q iaai.Cdl., <br /> CONTRACTOR NAME: t. e—cli45 eto/,e .l <br /> C.olt G <br /> IMO GG �/ <br /> CONTRACTOR ADDRESS: STREET 177 7 ..s7 C44✓4t hip 174 of #Sl y <br /> CITY Qui bit,fI4 STATE 4/14 ZIP 9fr 227 <br /> CONTRACTOR PHONE: Lo-f--f?O_ 6.2rO CONTRACTOR EMAIL: kjiO4.01 f Z.e4444 4 6"f„, `,GQAi( <br /> CONTRACTOR LICENSE#(REQUIRED): LEA in E 1-71. 07 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 44I CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: f / CONTACT PHONE: j" . '--f 7 G-- O2 J 'a <br /> Pea.9( jZe�ka l( CONTACT EMAIL: /. 04 2.e aft 4 /4 Cei n.„. L eri7 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ,sr jT Contract Price of Work:$ 2 .1`o, 00 0 <br /> Proposed Use of Building: '2 r Q f;,I y tot sr,fl' Heat Source: KGas ❑Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached XDuplex Multi-Family #of Units: 2. ❑Commercial El Industrial <br /> Type of Project: XNew DAddition DRemodel ❑Repair DT.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: J'jka(of hew. Ottiple . 2 ffe -7 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: 1(New _ Addn _Alteration _Repair Type of Project K(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 & Toilet Backflow Preventer(Inside Bldg) <br /> 'Z Forced Air Systems Unit Heater li Bathtub Urinal <br /> f Gas Piping Boiler 4 Lavatory(Wash'Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> 1, Gas Fireplace Wood Stove 2_ Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting 2, Dishwasher Roof Drains <br /> 'Z Clothes Dryer Hookups Other: `2— Clothes Washer Medical Gas <br /> 2 Range Hood ® Water Heater Other: <br /> Exhaust Fan .4., Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I 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 /> PERMIT# <br /> 19te.A , tee•I '1'4-r--/F' C (SO -Doi <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> 1 <br />