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PERMIT APPLICATION <br /> BUILDING/ MECHANICAL 1 PLUMBING /SIGN ISRINKLER I DEMOLITION <br /> ' ..� CITY OF EVERETT PERMIT SERVICES <br /> • <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: 7' � L&'L Y Ai/ w'` PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Yin CA OF c'f ' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Z 7 Zo ROGkor Pik,E ' 4(/e' .t <br /> CITiY, " STATE IA)PiZIP 7gz.e3 <br /> OWNER PHONE: ' 3 7 H " 5 j 7 OWNER EMAIL: <br /> CONTRACTOR NAME: 1,0 AC)L/Nl ha Demo t' '1 <br /> CONTRACTOR ADDRESS: STREET 3 3 j cA`E_Sl lu't 5"1 <br /> CITY �;1' STATE Iry �ZIP /21 <br /> CONTRACTOR PHONE: L'Z.ej-3 3 9- j/ ( CONTRACTOR EMAIL: /Y)J �" p I.(J/E'GkdAybiC/'C!e too L <br /> CONTRACTOR LICENSE#(REQUIRED):IJ1�reCk.bd 07AI\(,i CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):O))3f�)( <br /> PRIMARY CONTACT: ❑OWNER XCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACTj NAME:] CONTACT PHONE: 1-1Z.j^3 Z 3' 57 09 <br /> $ rid el Sl i 14 t - CONTACT EMAIL: n 11`ch 5 w tfaisitAttiternt , ('_d fts <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: V tee.. Contract Price of Work:$ r2-00 <br /> t 001-',v - <br /> Proposed Use of Building: Heat Source: OGas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New DAddition ❑Remodel El Repair DTI. ❑Sign ❑Sprinkler, emolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Demo 1;5 . £x s-t,„:5 bl4-3 <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 of List of Fixtures # 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 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 ' 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 /> 9 / `8/ PERMID \fQ <br /> 00\ • <br /> wner/Authorized Agent Signature Date (Revised 9/23/2016) <br />