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41677PERMIT APPLICATIOF <br /> BUILDIN i I MECHANICAL/ PLUMBING I SIGN . RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> i- PROJECT SITE INFORMATION T :'. : <br /> P+RO ECT SITE ADDRESS: cepPROPERTY TAX#:(1051.1 tieli(..),.� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> i - . _ . , - . �.1,,`. ,CONTACT'INFORMATIO,N`.. .. <br /> OWNER NAME:E\le.S6 ,vc f 1 O NX1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREET .t r t.\*1 l <br /> CITY�v } �� STATE 0"_ ZIP�'•t��..©(... I <br /> OWNER PHONE: OWNER EMAIL: 1 L,� <br /> CONTRACTOR NAME: VQa.\� \qi‘. <br /> CONTRACTOR ADDRESS: STREET 1Z!)56 0 7G \j . \ <br /> CITY<A4\-101 STATEk.1.3ZIP 9ii <br /> CONTRACTOR PHONE: g 'p9 _I 1i CONTRACTOR EMAIL: (1S t ",A.,.(N4�C*0'.,Q\+co 4Y\, <br /> CONTRACTOR LICENSE#(REQUIRED): `p© \-Wen-90-M CITY OF EVERETT BUSINESS LICENSE#((REQUIRED):b eaSci(p <br /> PRIMARY CONTACT: 0 OWNER IONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: l..k . -2,\,-C(3C:k LA <br /> -o\t \C\ W\..\\Q\1 v -S CONTACT EMAIL: ' \��`‘notZtt Q.C5\4 CIDP <br /> .-.•.•.,:.!;--- --!--' ,:-,;,;. ":, : : :. BUILDINGPERMIT APPLICATION <br /> Existing Use of Building: YYYL1\\,--N-00'1, \9 Contract Price of Work:$ -7i 50 •— <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ' Multi-Family-#of Units: 4 OCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel eigepair OT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> D SCRIPTION OF WORK: , ,w,....! • it _ t s::.- t'.y ri <br /> ASSOCIATED BUILDING PERMIT#(if applicable): N "vecatAc" <br /> MECHANICAL PERMIT APPLICATION:;!-;::. - •PLUMBING:PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Adds Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of 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 /> SPRINKLERI.SUPPRESSION SYSTEM: <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 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 /> B itelln Official before being authorized under any circumstance.lam the owner,or!am authorized by the owner of this property to perfomm the work for which application is made, <br /> a d l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Cityof Everett Official Use <br /> Only <br /> , , <br /> -i PERMI l4�nO ( - Ot°l <br /> \lir, . -4# <br /> • . uthorized •gent i a e Date (Revised 10/12/2015) <br /> I2, <br />