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11, PERMIT APPLICATIOS <br /> BUILDING/MECHANICAL i PLUMBING 1 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 rBliack InkOnIY nas j PROJlI CT;SITE IrNtORIIIIATITCI+I <br /> PROJECT SITE ADDRESS: /i=`t) W. d i4 S;too 1ZO Eutfi,}4 we, qg PROPERTY TAX#: 6039 1,I 000(3r5 ;0 l <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ONTA+CT INPCIRMATlllP4 m; <br /> OWNER NAME: &(?.E. e a&f I t, &00d LL-C_, TENANT NAME(If Commercial): NO Va_ Akeifit s <br /> �ta/ <br /> OWNER MAILING ADDRESS: STREET a516 I A j ci,S IC4 h) (A94t, c 3I0 <br /> CITY S 644411 STATE ( ZIP ei�4�+t <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: dar1 or4- o f tutI$�+iN i I/J /iIt)t A <br /> CONTRACTOR ADDRESS: STREET ID-() c 3 - <br /> .. <br /> 3 <br /> . _ . _..__ CITY ISpi t io STATE IVA ZIP / %P. <br /> CONTRACTOR PHONE: 3 6t) gall /,)..o CONTRACTOR EMAIL:Of,,,,, 6, e,,„,r ✓/ Sib-Al}O yll,C„m <br /> CONTRACTOR LICENSE#(REQUIRED) ,r pQ O f 115 CITY OF.EVERETT BUSINESS LICENSE#(REQUIRED): 500(,,I/ <br /> PRIMARY CONTACT: 0 OWNER a CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:7 0t v er&fr/ CONTACT PHONE: 3(o O q R'7 ` A.00 <br /> CONTACT EMAIL: ttp,edi,rlporic orwastiIn'1 kW,Coin <br /> BI,I:'Ig IWPERMIT APPI IICA TION <br /> Existing Use of Building: Contract Price of Work: $ O T 0,356 <br /> Proposed Use of Building: CA Por1-S Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SPR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: S peZ i`et I fY eiwrit J <br /> Cam'""ar <br /> S�e I fl'1/ �i� <br /> ci <br /> ASSOCIATED BUILDING PERMIT#(if applicable): I iv 5 f A it 200ifity <br /> MECHANICAL PEoMIT APPL ICAIF'ION; PLUMBING PERMIT APPLICIITION< <br /> Type of Project: _New Addn Alteration Repair Type of Project: New Addn _Alteration Repair <br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #°f 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 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 Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 7i1/ —3t ( L — © 13 <br /> Ovvh r/Auth 1 ed Agent Signature Date (Revised 9/23/2016) yz. <br />