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v <br /> 0 <br /> PERMIT APPLICATION • <br /> , 41477- <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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: )j,).)-(o RANI? f4vk . PROPERTY TAX#: 004 (.)t 5 913 0 I 61 0 O <br /> LEGAL for new construction: Short Plat/subdivision CA.""Va I.i-ttt-t.. tr l)v• Lot No. 14 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: STAG-I t,%,)V-I tT LOG.K TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET .).1.)-(0 �Nil 1 ( J <br /> CITY EvE.R.STr STATEG.) ZIP dig).Qk <br /> it <br /> OWNER PHONE: a• `-S SO`1 -GO 1 OWNER EMAIL: S-1"AC,I �J I-I IT LC),C.. ` e E-1AAtL 1 <br /> CONTRACTOR NAME: l -rj f _j1]'e j� <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: A'OWNER ❑CONTRACTOR BcbTHER(Please Specify) --A-VA ENAO .0'i' OW JitLf.— <br /> CONTACT NAME: wt. ` 6 _ .,,�p CONTACT PHONE: ' - q _6� ,`"��Q y <br /> l�^�'I l YL_ CONTACT EMAIL: `v3 ci u..44 t�Ck,i 2ikt \.r 01-'1"1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Crrkg A CrL- Contract Price of Work:$ )...0 YAD ' kAt—u <br /> Proposed Use of Building: $f`yR (DAD U) Heat Source: ❑Gas Ltlectric ❑Other <br /> Building Type: KSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition tarRemodel CI Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: C.-ON .0t2M L'_y"(5-11+ (j-ANAC _. STt(LOCZ m <br /> /rLLQt4 -Ua. A wiTl ON/t+— L_ i VL!\J, - AVZE.A . <br /> ASSOCIATED BUILDING PERMIT plica e sn o�v_x k. 0 0 Ac L t v t-t- r"QAtAb <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 I Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems V Unit Heater Bathtub Urinal <br /> Gas Piping Boiler i Lavatory(Wash Basin) Drinking Fountain <br /> i Water Heater $ Refrigeration t Shower I Floor Drain <br /> Gas Fireplace Wood Stove I Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting i Dishwasher Roof Drains <br /> i Clothes Dryer Hookups Other: I Clothes Washer Medical�G■�a�ss <br /> ( Range Hood ( Water Heater I Other:£ViU'Ivc- (At- <br /> I 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> ____--- 1 l a G0 (gad 00,3 <br /> O nfA ,-\\n/z--- <br /> uthorized Agent Signature Date (Revised 9/23/2016) ---- <br /> ( II. <br />