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'IP • PERMIT APPLICATION ` <br /> (0 0J1811(24AAAj <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> ��,,,/ CITY OF EVERETT PERMIT SERVICES <br /> 41 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 Q <br /> PROJECT SITE ADDRESS: 3 3 Lk, P� �� ,- PROPERTY TAX 100Lf3 1 O7'f 7O j 7Vo <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) + (.,--le..-. f lIA1A) <br /> CONTACT INFORMATION v/ <br /> OWNER NAME: G 'vietcex- &Lap Li.L. - TENANT NAME(If Commercial): 5141 v/A•vtJ A,a. 4 <br /> ,OWNER MAILING ADDRESS: STREET 3j fig/tie..- Q-- <br /> CITY Y V—V.*+ STATE c„..)/ ' ZIP 9 8 z_o 1 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 0-- 12.44ezis I,...-.C-.. C. <br /> CONTRACTOR ADDRESS: STREET 5 00 S c,A) 1 Q H'.. ''--// Q <br /> CITYYy,,, �` . STATE CA ZIP / e O7 <br /> CONTRACTOR PHONE: q25 40-7�OnOSe CnO'NTRACTO EMAIL: l` ® (Y% 1 e ( 4 <br /> CONTRACTOR LICENSE#(REQUIRED)C ia LJ .�1I 3VERETTBUSINESSLICENSE#(REQUIRED): y0?q • <br /> PRIMARY CONTACT: ❑OWNER %CONTRACTOR 0 OTHER (Please Specify) <br /> CONTACT NAME: . CONTACT PHONE: 4`J ' 2..-O ?— ,00 5 e A <br /> A ,�� /�4) )O ST 1 I 1 V CONTACT EMAIL:14'vl"3 /" 'rL�N/ C/k"s, CQ� '\ <br /> BUILDING PERMIT APPLICATION ��1 J <br /> Existing Use of Building: I(.J rk OVS� Contract Price of Work:$ ' O <br /> Proposed Use of Building: ( E-15 54-0 Heat Source: XGas ❑Electric DOther <br /> Building Type: DSFR-Detached ❑SFR-AttachedDuplex DMulti-Family-#of Units: 'commercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel DRepair *.I. ❑Sign DSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:v HA,r ij it A4'C'l t��s 4-4- c.2,-1) r{ s O F�j Pedi- iyhac, ��. " _ �,m L,1 ) I <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> b 2y�klee*r Avg rL.� <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 #of 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 /> t;as Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> - <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 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 Contrac ors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 0V� ,:�'� Me- kt U-L-- c:. zs12az a P ` 0 — ®k,.P <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> I. �' <br /> J <br />