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4110 S <br /> PERMIT APPLICATION <br /> BUILDING 1 MECHANICAL/PLUMBING 1 SIGN/SPRINKLER 1 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 wwweverettwa.gov/permits <br /> : <br /> • <br /> (idlue.®r Drackc fil Only.Please) . . PROJECT sRRTTE INFO: IviATION •_•. t,c <br /> PROJECT SITE ADDRESS: °7D 3 1�- ld- 11101/ !PROPERTY TAX 9 4t2 6D0/`19D <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of tong legal description) <br /> . .. CONTACT IiIPIlkfvfATiom • . <br /> OWNER NAME: itiif2- t g h M "" d3#(' A TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 10.3 74G -Ar'e-A) 1,1, <br /> ,'4`,p q <br /> // Cirr � / <br /> ,, STATE 14. ZIP <br /> OWNER PHONE: K j 3'2-/— Le5 OWNER EMAIL: R P G EiP vtg,b3,_.:.. ' <br /> CONTRACTOR NAME: EV 6 Tt Tcr 6. f'4-.. <br /> CONTRACTOR ADDRESS: STREET E;d-- 61 I2,0 PA1, (�cgr • <br /> ITY UW STATE W Q ZIP N 632e <br /> CONTRACTOR PHONE: 4"2-5.2-e;2.'15(I4 • CONTRACTOR EMAIL: 'AAA-0 ._53 L)a L <br /> CONTRACTOR LICENSE#(REQUIRED): E06 3S case)`r 'CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CI a,•-i q 5-5- • <br /> • <br /> PRIMARY CONTACT: 0 OWNER RCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4' coo-2-5-2 d°72/f 1 <br /> KA A- e i"-•• CONTACT EMAIL: NM* 6P c,S5 MwA ..C <br /> - DI1ILDMG PEflIVMIT APPLICATION <br /> Existing Use of Building: v ,CGS ' 1 Contract Price of Work:$ 57/OOD <br /> Proposed Use of Building: <br /> D C', G0- Heat Source: ;='Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached CISFR-Attached ODuplex ❑Multi-Family-#. of Units: WICommercial ❑industrial <br /> Type of Project: ❑New DAddition ElRemodef ❑Repair CIT.!. OSign ❑Sprinkler ❑Demolition CDChange of Use <br /> DESCRIPTION OF WORK: Rowe, Lg y/a_cf �K /2� kit-f1 ttt,,,:'' �'yN , tve,Aw.44, s4,6 U 4,, r_ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> .IVIECH AldJCAL4 PERMIIT APP><ICA I I N . ' • . PLuMEINO PERMIT APPLICATION <br /> Type of Project: New Addn Alteration oC Repair j Type of Project: _New _Addn Alteration Repair <br /> of List of Fixtures r #of List of Fixtures I rr of List of Fixtures #of List of Fixtures <br /> Fixtures <br /> Fixtures , j Fixtures Fixtures <br /> NC—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 /> • <br /> Gas Range Ducting Dishwasher Roof Drains • <br /> I • . <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 /> . 11=i1KilYCLERR l•§OPPR-IEPWiAl.SYYTI GVI . ' : 1 <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 permitmust 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 underany circumstance.lam the owner,or!am authorized by the owner of this property to perform the work for which application is made, <br /> and!comply with the State Contractors Law 18.27RCW and 293..200A WAC. <br /> City of Everett Official Use Only <br /> PERVI0�^ `12/ q Z.D N 1)._ O . <br /> eS. I <br /> Owner/Authorized Agen . nature Date (Revised 5/20/2016) . <br /> L/Gi <br />