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OrETTPERMIT APPLICATION <br /> BUILDING- MECHANICAL/ PLUMBING I SIGN I SPRINKLER/ 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 /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: .,_ PROPERTY TAX#:ricA c- -_ ., ��- <br /> 1�r1�\r1�S �d-13'7 �� '-�/ / <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Eve,(e:• Oka ' r k N ?c-‘k\ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: unser?. lir' ,51.\---1 <br /> CITY Vice STATE W ZIP9) i(0 At <br /> OWNER PHONE: OWNER EMAIL: 1 � <br /> CONTRACTOR NAME: S Via.\ \Ni\g <br /> CONTRACTOR ADDRESS: STREET t S )C,` lKck- <br /> rr��cITYc a STATE \::::}- ZIP 9 a rLI <br /> CONTRACTOR PHONE: plk�'9 Li CONTRACTOR EMAIL: ("l • Ns(\.\,,,A•(\p� O,Q\•CZ M.-, <br /> CONTRACTOR LICENSE#(REQUIRED): Cop\_ 6`). 9'2)L\ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):(::)5")34:1(.0 <br /> PRIMARY CONTACT: 0 OWNER IeONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Lkr . -@.\ -C(3q L) <br /> -o\Nc\ W 1,\\'ore CONTACT EMAIL: r- o pnk\N,c\ -. x\ Q-t c \. Do- <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: YY\\1..\:v-VGtY‘r\L' Contract Price of Work:$ .7I c •— <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex Multi-Family-#of Units: L+ ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel Repair ❑T.I. ❑Sign El Sprinkler ❑Demolition ❑Change of Use <br /> D SCRIPTION OF WORK: (v..' t• .. r c ` -` 5. :t•..- -4".vet_ <br /> r ' * / I • <br /> u - ` �! rDCf over .€i '$v•r3 \ \Qy es-- '3-fib. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): %:i( --T i <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New Addn Alteration _Repair <br /> #of List of Fixtures #°f 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 /> SPRINKLER/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 /> 8 '• •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 /> a d l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Cityof Everett Official Use Only <br /> 4 IT <br /> f. 19"1 PERFItOO J O t_.7 <br /> •'* uthorized •gent a e Date (Revised 10/12/2015 t <br /> rj <br />