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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> '4441W CITY OF EVERETT PERMIT SERVICES <br /> r 3200 CEDAR STREET, EVERETT.WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 vvvvw.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION // <br /> .J 0 0 <br /> PROJECT SITE ADDRESS: t+t'S 7€1-14 SC', S. , PROPERTY TAX#:28044,100 1 OIC <br /> LEGAL for new construction: Short Plat/subdivision Lot No. _ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ,5A'BE\ CUR42 , TENANT NAME(If Commercial): pizoltep..E .Pix-nniGS <br /> OWNER MAILING ADDRESS: STREET V212.0 1 uel.,I I L4 rY QT{ t' 1 -ts T/I i..)AL__ 1:3.1.A)0 <br /> pt/�Q� <br /> cSTATE Y Ac i 9 <br /> . ZIP V/E D <br /> OWNER PHONE: GOGG 22I 4?-000 OWNER EMAIL: P.-p1 cQ SAg / . Corn <br /> CONTRACTOR NAME: SAf3 E7 c.Q s-r-ZU C-R-01..J - 7.-O r_D lOTLe"2- <br /> CONTRACTOR ADDRESS: STREET 1 STD I 1 U IG W I LA I V.)-M 2.NATIb$-141.L-. R L U rD <br /> CITY Sep T"TLG STATE 01%14 . ZIP 13! (p <br /> CONTRACTOR PHONE: 24 . '21 7 .S'2.4-I CONTRACTOR EMAIL: v-OI $ CO@. Sitije•Li , 1-41 <br /> CONTRACTOR LICENSE#(REQUIRED):CC/ SA 'YI1S3 KM CITY OF EVERETT BUSINESS LICENSE <br /> PRIMARY CONTACT: ❑ OWNER J CONTRACTOR ❑ OTHER(Please Specify)P 66 5 '2 404 <br /> CONTACT� NAME:. CONTACT <br /> CONTACT PHONE:2.0 . ^473 , 02,9 0 <br /> r-- � 1;3 <br /> ICU-i v�� CONTACT EMAIL: 'FjpbI7 Q e„rbe A 001„.c---_ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: JA(AI2 e 4 OJTb Contract Price of Work: $ IV) i S38- <br /> Proposed Use of Building: 14.1aQd6140 J `,;:- Heat Source: &Gas 'frElectric DOther <br /> 3uilding Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Ell Commercial VIndustrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler : Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> IOVIVIOOn -- OF' kowS-1,24 <br /> ) — crU12�AL. WALL_ S aq SML. <br /> D L i <br /> Lw-t7t4 D2_ <br /> STbr+P At p>J6 i U 1 L-dis,)� -qcb o s p. <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 /> Sof #of #of It of <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures _Fixtures Fixtures <br /> A/C—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 HoodWater Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Chemical or Water No. of Heads <br /> ICKNOWLEDGEMENT::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 /> :urrent 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 /> 3uilding Official before being authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> :nd I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMI # L)01 �©s I <br /> >wner/Authorized Ag t Signature ble �l (Revised 9/23/2016) <br />