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PERMIT APPLICATION. r BUILDING / MECHANICAL/ PLUMBING /SIGN I SPRINKLER I DEMOLITION ` //--�� CITY OF EVERETT PERMIT SERVICES IlliN —- 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: €,2.0 t t1'4 ST #' Fla PROPERTY TAX#: 286 Si 9 003 02.500 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION 1 OWNER NAME: I�Q 0 f . P!_ft-j(} VI LIA L.L,CIENANT NAME(If Commercial): �0p�1 /1o4 "7 OWNER MAILING ADDRESS: STREET 44Z �� Se- 27 ' sr, so,TE /� criv ! 4 Fes-[. y� ) J,t. G t � STATE LA-A- ZIP /$0'7`L.2 OWNER PHONE: . i'4II - 81422. OWNER EMAIL: Z,1Ll E CPAr1NerR -Ecrri TE CoM CONTRACTOR NAME: Rt '1 tJ ° 1Z., �V !jS� CXL) Ps •L , C.,, .r CONTRACTOR ADDRESS: STREET 7 2(0 S6- 21 �1� `4.6Si--, Sv i i Z6 cn / 12 S L{1 STATE A- ZIP R SO* CONTRACTOR PHONE: q2 - 28 1 -6 61„i;4, CONTRACTOR EMAIL: .C",Qti/l CONTRACTOR LICENSE#(REQUIRED): kii-trJ/S' ppi sal CITY OF EVERETT BU ESS LI ENSE#(R QUIRED): q(✓ i. PRIMARY CONTACT: O OWNER 'CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 4/2 S 28(„ 66 2.c, VA Cl 02)(2_(,1 CONTACT EMAIL: Ch ' ,1/4((a op a,t I .�.o M BUILDING PERMIT APPLICATION Qom` Existing Use of Building: Contract Price of Work:$- $ 40/0 ) Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex OMulti-Family-#of Units: OCommerciai ❑Industrial Type of Project: El New OAddition ❑Remodel ❑Repair 0T.1. ❑Sign ❑Sprinkler ODemolition ❑Change of Use DESCRIPTION OF WORK: 'il'�srrfl' �'!'1 \ o N 1✓t,.a MF t Vi,A-4.2-UQe 446,A4c- I,-iw Ex.tcrir)&I 5Le r- 0.4 mittss . t-tomiC pale .. C-I 4a be- Advi A-- kuA, ASSOCIATED BUILDING PERMIT#(if applicable): A'LcoN(a v,-aTt-t sta.P S S SryAu-- bez-b 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 Refrigeration Shower rTloor 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 I SUPPRESSION SYSTEM Chemical or Water I INo.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 l am authorized by the owner of this property to perform the work for which application is made, and/corn with th ate Contractors Law 18.27 d 296.200A WAC. City of Everett Ofcial Use Only a `�V 4-/— � PERMITS� �� 05� 0 a uthorized Agent Sig atu e Date (Revised 9/23/2016)