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-26t COS , 59 <br /> orp.. ___ , .,.. <br /> PERMIT APPLICATION -.)l(C ') <br /> BUILDINGS 1 YRRECHANICAL I PLUMBING / SIGN / .W1RINI'LER/ 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 '•lease) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 110 1 V1 ie.) G U1 /8 Xoe PROPERTY TAX#: 0 Q 3 61'Z(3 Do-mo 1Q <br /> LEGAL for new construction: Short Plat/subdivision Q) Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: coo wa 00 -t14 LCd I�-^ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET S G,d^O [��I NA'�[•L) Z c • /�(� <br /> CITY £�A L`�C�s STATE �/ ZIP L �j�lJ <br /> OWNER PHONE: -33/ -.2.,(12_,C; OWNER EMAIL:5 ft,14J icul- -ISa.A0K.• CM <br /> CONTRACTOR NAME: A -® CL �o lite_.. <br /> CONTRACTOR ADDRESS: STREET <br /> CITY .OD �VLI� STATE W•� ZIP q s,��u <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: i.-0 bilk/ E> pc,Aab ! awl <br /> CONTRACTOR LICENSE#(REQUIRED): �� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) <br /> ` <br /> t-t <br /> PRIMARY CONTACT: ElOWNER ❑CONTRACTOR CJ OTHER(Please Specify) OA1Y1V- f- <br /> CONTACT NAME: �/���®_ CONTACT PHONE: &ISS• SS'C,i. t co ZS- <br /> �� e`- CONTACT EMAIL: S 1rt,et a I,} t ,44 t a SOn •mV, <br /> BUILDING PERMIT APPLICATION / <br /> Existing Use of Building: Contract Price of Work: $_ e ,SLA lC�` <br /> Proposed Use of Building: 'LIi2Li.:X • , Heat Source: DGas Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel El Repair DTI. ❑Sign ❑Sprinkler DDemolition El Change of Use <br /> DESCRIPTION OF WORK: <br /> AV,€� _ .I. CO LC1Os <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: X New — Addn _Alteration _Repair Type of Project: lew Addn _Alteration _Repair <br /> #of #of List of Fixtures List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> 'A/C-Air Handling Units • Heat Pump Co Toilet Backflow Preventer(Inside Bldg) <br /> "Z_. Forced Air Systems Unit Heater -. Bathtub Urinal <br /> j- Gas Piping Boiler [p Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration 2, Shower Floor Drain <br /> Gas Fireplace Wood Stove 2, Kitchen Sink&Disposal Grease Trap <br /> Z Gas Range 2. Ducting 2„ Dishwasher Roof Drains <br /> 7_ Clothes Dryer Hookups Other: 2, Clothes Washer Medical Gas <br /> gRange 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 authorized under any circumstance.I am the owner,or/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 OfficialC <br /> Use Only <br /> PEE\#eq 2 <br /> 4 <br /> Metcot},./Iim _4.,----pm /.?- --/7-- <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> '.-t( <br /> I � <br />