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PERMIT APPLICATION <br /> /41/0. ----a BUILDIN - 1ECHANICAL/PLUMBING/SIGN / NKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> P OJ CT SITE ADDR SS PROPERTY TAX#: <br /> 5p Sr 1,.l, �I'etrv'T-rI wit �1�20'3 00� 5poo<�13(�D <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1\16(n[A/I Ali e,1/1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 424 SrSta,.! <br /> CITY Fv•evekr STATE VV„ ZIP 61�/D11� <br /> OWNER PHONE: `' OWNER EMAIL: r <br /> CONTRACTOR NAME: IkAy ai/i yytkpm61 to(l, <br /> CONTRACTOR ADDRESS: STREET t1?)6 Wt CZ 1 vn 12,4 #t43 <br /> CITY sV?,Y,fXi- STATE WC).C). ZIP 620222DH <br /> CONTRACTOR PHONE: (2-61 ) `'b--- I t c191 CONTRACTOR EMAIL: pal V1(411,00%v116 G)mot(i, ('0 Ki( <br /> CONTRACTOR LICENSE#(REQUIRED): I X P Lit„1P,•�, 4 b3 1,g CITY OF EVERETT BUSINESS UCENSE#((REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ,CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:V.410) (i1,lQ-I-k1/4‘27-1 <br /> NelSoYi CONTACT EMAIL:i X \uyylIG;V J (00)iMa�j, Gflh4 <br /> BUILDING PERMIT APPLICATION J <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: OGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition lEffiemodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> tif6lait 0 1,Wil'MIS 0 OCIO-*Vir, ICCO;h04 <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 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 I Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 1 Bathtub Urinal <br /> Gas Piping Boiler 1 Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove 1 Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other. 1 Clothes Washer Medical Gas <br /> Range Hood 1 Water Heater 2... Other: t{occ p»I„s <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 /> Building Official before being authorized under any circumstance.I am the owner,or!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 298.200A WAC. <br /> q I City of Everett Official Use Only <br /> PERMIT# <br /> Ow =r •uth', �r' gent ignature Date (Revised 10/122015) <br />