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4677 PERMIT APPLICATIO <br /> BUILDING.ECHANICAL / PLUMBING /SIGN MP RINKLER I 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: IS.-52 (VAJ(,S AMIE,. PROPERTY TAX#:Do 1 2 30 3 D 1 40 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. _ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: E /I iJ Vt I?'1 I$J TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET I632, CAVE E5 Mile . <br /> CITY T\/E R e. `1 �/�,,�e�; STATE �� ZIP 1 2, � ' <br /> OWNER PHONE: �-J -,Q c1-. M�Cv� j \\\ OWNER EMAIL:Nl'Y`i� p C. k) ( L I�r-,,k_.C c t <br /> CONTRACTOR NAME r„dg - \" 1uLACX-\ ‘.).‘eCksi..,'1 ,,.. CA.A <br /> eRY AnCYjekIA <br /> h <br /> CONTRACTOR ADDRESS: STREET I i717>kN • kF; vaP S-\'. .- tecc-= -"kl. 3 j <br /> CITY \T---‘\ 34'4)U . STATE r\,., ZIq -1. <br /> CONTRACTOR PHONE:3�L�; FP-. 9 t CONTRACTOR EMAIL: jH1(\�� jK � CjF.� <br /> CONTRACTOR LICENSE#(REQUIRED):Q ct4L,4C)—1. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) D Q`0 s <br /> PRIMARY CONTACT: El OWNER El CONTRACTOR ,�l OTHER(Please Specify) ��MT �alv Q)(� I / <br /> CONTACT NAME: MAIM IJ ge EMI (r A,4 CONTACT PHONE: di 2.6. <br /> ' 's i T I` 1 _" — <br /> (4.cri Aeakt r'�GloomCONTACT EMAIL: M r1ei ltiter C 6Acer't0.vziAI +'t ore. i ON <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 5ra, Contract Price of Work: $ 6 0, COO., <br /> Proposed Use of Building: 10NnII,. Heat Source: I1Gas El Electric GOther <br /> Building Type: titt FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition Xemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> J 'iO ofc, eit isl. EM fir (Mot4.d. 2. 8ocombbPus) , ad-►) ":36"4" <br /> SsitSTtial iercus L. pe_Lowd e_L / - A <br /> a <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 #of #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> A/C—Air Handling Units Heat Pump a, Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater / Bathtub Urinal <br /> aGas Piping Boiler -„°/ Lavatory(Wash Basin) Drinking Fountain <br /> � Water Heater Refrigeration Shower Floor Drain <br /> ,d' C Gas Fireplace Wood Stove / Kitchen Sink&Disposal Grease Trap <br /> ' / Gas Range Ducting / Dishwasher Roof Drains <br /> / Clothes Dryer Hookups Other: i/ Clothes Washer Medical Gas <br /> / Range Hood Water Heater Other: <br /> Exhaust Fan fi ``a') 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 /> ^l,� - PERMIT# City of Everett Official Use Only <br /> / ® �/� <br /> / <br /> _caner/AutJrized Agent Signature Date (Revised 9/23/2016) <br /> L <br />