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4747T PERMIT APPLICA1 <br /> BUILD. / 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 /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: <br /> (opt Se. Evtret+ MY1a11 tAltxy Ste. IJ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Lone Lel w of TENANT NAME(If Commercial): —slanders &tort <br /> OWNER MAILING ADDRESS: STREET (007 SE. Eve <br /> re-}+ h1a11 Way S ie. 14 <br /> CITY �tr,2 STATE A/A ZIP 9 2 2OA <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: r313 515n Services <br /> CONTRACTOR ADDRESS: STREET 1102.12.. 13o})ie 1 I eVere - Hwy F 239 <br /> CI Y rn 111 Crte STATE \Af ZIP 9 SO12_ <br /> CONTRACTOR PHONE: 425. 330. S)bO Q CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): 13(3TS 1 Si-9�O '7O CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 055 I 0 y <br /> PRIMARY CONTACT: ❑ OWNER `. CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: fang/ C70nzaI-eS CONTACT PHONE: ij25 •330gI(oO <br /> CONTACT EMAIL: bbtS19nS@rnsn, COf'll <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: C.OM Mar CIA.I /re-f-a I I Contract Price of Work: $ 25(3. ov <br /> Proposed Use of Building: N J)A Heat Source: OGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: 'commercial ❑Industrial <br /> Type of Project: New ❑Addition ❑Remodel ❑Repair DTI. Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> l rrbfia11 CI) LED channel le+#e-r S19n d,lsplay <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 f #of <br /> List of Fixtures #of List of Fixtures #of List of Fixtures 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 /> Number 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 o/ ��of Everett Official Use Only <br /> 0 ((J. 03. 20� PERMIT#`�"YV 0 0 <br /> 3 <br /> Owner utho ' ed Agent Si atur Date (Revised 10/12/2015) <br /> 9/%2 <br />