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L04k£4 -ft, Pwrlm-005 <br /> OLT PERMIT APPLICATION <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 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3313 00-1-;•- .5 e.,vP-flat (A) H- PROPERTY TAX#: 004390 79 <br /> 4 00200 <br /> LEGAL for new construction: Short Plat/subdivision \)t 1\t"b Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Rai h -e)- 1 ,%4;\, 4. <br /> 5.eArrsicif a TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1 •0. 'Btu 1,1 4,7 nry <br /> CITY e Vev^0-1— STATE W ZIP 99 Z4 <br /> OWNER PHONE: 41S• 8,4 • 406,0 v <br /> II __ /� OWNER EMAIL: Cki5 0 ow <br /> -lei vrtc i t 2 • CDH-t <br /> CONTRACTOR NAME: t� r+i1t rSt-l0-G3'r!d <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ii-OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT1NAME: CONTACT PHONE: 47-5- • 864 . 106,0 <br /> l� f1,Y`1 6 b lq d /y - CONTACT EMAIL: C• I\T e C©u,n e y f Z . c fl►+,, <br /> BUILDING PERMIT APPLICATION / r/ <br /> Existing Use of Building: v6(,Cavd Lfft Contract Price of Work:$ I Q 5 2_?3 5 ( CS'-('TM x) <br /> Proposed Use of Buil ing: Ij I'^.5(Q " 4I 1,7 ,S f A kki Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: I�0"8 -Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: -®1Qew ❑Addition ❑Remodel ❑Repair ❑T.I. Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: eyt.t.a,( ial-j - # 5 1--yew 0.-- . r- enn��,rk,.G/Lj a� 04- Q?s f- *-1. 1 8_ <br /> -�►�i 11 re sal,,,c�- , <br /> wl re it` r 1 ear i� qf-'Fae.LP <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 #°f 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 /> 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 .Roof <br /> Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> • <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.- .re being authorizedder 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 h t e Stat: >,tracto - �w ;.27 RCW and 296.200A WAC. <br /> / City of Everett Official Use Only <br /> PERMI # <br /> Owner/Authori i, Agent Signature r <br /> Y gn atu a Date (Revised 9/23/2016) ( � <br />