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PERMIT APPLICATION <br /> /411#4. ---1 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 I(E)everetteps®everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 5010 _Oaf' \f MAO Qr. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ev..e/tf ' P�y10I;L Schopk TENANT NAME(If Commercial): ,( (Ste4444.14A-cA <br /> OWNER MAILING ADDRESS: atm r o ,ulrpgc .9.041A <br /> cm Ivan:`-_ STATE IAA' ZIP 1130,0,5 <br /> OWNER PHONE: -..,---.__ OWNER EMAIL: -- <br /> CONTRACTOR NAME: (AJ e, k-erel Re c exi ca,f IAA ka.c.f Ors <br /> CONTRACTOR ADDRESS: STREET I9(( 50 CX.‘r1Pws 4r•. 4t59,1 <br /> Ctrs rG pok (A .&4 STATE IA)4.- ZIP Qe)Q <br /> CONTRACTOR PHONE: ?) alN.C.o 419{1,( J (CONTRACTOR EMAIL: C-M r1s , oeskeM rne.J 1 LIS <br /> 77��� <br /> J <br /> CONTRACTOR UCENSE#(REQUIRED): IA w c.. /Z,e{ &L CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 4951•9364.� <br /> PRIMARY CONTACT: 0 OWNER E4ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT AME: CONTACT PHONE: x.53 4111.co ci5'c lL( <br /> lAjar•-- 61..-rre)A CONTACT EMAIL: braitae6frn yyteP41.,, is <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Gle b.ev4t t )11oO' Contract Price of Work:$ ({Der ale" <br /> Proposed Use of Building: `m.w..e. — Pe, Cheaak�R- Heat Source: OGas ❑Electric ❑Other <br /> Building Type: DSFR-Detached DSFR-Attached ODuplexle �,OMulti-Family-#of Units: commercial ❑industrial <br /> Type of Project ONew OAddition ORemodel DRe C ❑ <br /> air ap I.I. ❑Sign ❑Sprinkler Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: te <br /> ( r'&# crG� it,ii`kileek I o\. *.c icer 1..� (;k. <br /> raw e. 044.cCms <br /> . s 1 <br /> .1-l0 A�sse"b 1�1fi5 1-4%4 wwkr, Z Got u,a4e,). <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn Alteration _Repalr Type of Project: New Addn _KAlteratlon _Repair <br /> #ofList of Fixtures #°f List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units Heat Pump Toilet j., 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 1 Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I INo.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 0 - before being authorized under any Lance.I am the owner,or I am authorized by the owner of this properly to perform the work for which application is made, <br /> and 1.• •1 the State Contractors Law 18.27 R end 298.200A WAC. <br /> City of Everett Official Use Only <br /> /_ 9/ PERMIT#f sok /0 <br /> o1 <br /> • nen/ , hent Signature Date (Revised 9/23/2016) <br />