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• PERMIT APPLICATION BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: j 3 1 (2,8,1-.0 LA)ici l L-/fi4-071 aYL"l PROPERTY TAX#: 004"36 V 1-4 l D (CID LEGAL for new construction: Short Plat/subdivision I Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: b go IAD col j DA) A CT5 TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 11120 ►S A 14,6 CITY S -I-1 0/•t-l�� rf a3-155 OWNER PHONE: 2Q(A -L D— 1 l 'OWNER EMAIL: 31 3 ar qe`, t ct{M L;(� f1/1 CONTRACTOR NAME: el Orearl 3g.4i�'" Jfb . , CONTRACTOR ADDRESS: STREET 1-i-a--2� ' , Ai- j C� CITY S 1- )f`-1d L ;.ir STATE VIP ZIP law CONTRACTOR PHONE: 2 e W 27-1I-Gj 2JL4` CONTRACTOR EMAIL: SAP* .t @ C-Ill 64ILI± (%M ,e_b) CONTRACTOR LICENSE#(REQUIRED): �7 �IN ? I Q c CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (S(p 6, PRIMARY CONTACT: 0 OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: Si I CONTACT PHONE: '2Qt , 2-44- q 2,2 CONTACT EMAIL: S j-L1°t-Mh.,i t o 0 (-1 it-t- --' '12)N f L I N',A) covi l BUILDING PERMIT APPLICATION Existing Use of Building: p-,,o 'T f r orki Contract Price of Work: $ (20 i�-D- .-.- Proposed Use of Building: jt) C I1v'J/1 t< Heat Source: Gas ❑Electric DOther Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ulti-Family-#of Units: g ❑Commercial [Industrial Type of Project: ONew ❑Addition ❑Remodel `Repair ❑T.I. OSign ❑Sprinkler ODemolition OChange of Use DESCRIPTION OF WORK: Ravi)J C�I S]- J"t L H D j -t E i ;;y- Try),z,r I ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn _Alteration __Repair Type of Project: _New _Addn _Alteration Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping _ __ Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeratir Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER/SUPPRESSION SYSTEM Chemical or Water I No.of Heads 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 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 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, and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only r ri�l5/f PER wait - 004 ner/A ized Agen ignature Date (Revised 9/23/2016) 027)