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PERMIT APPLICATION <br /> BUILDIN&ECHANICAL/ PLUMBING/SIGN /*INKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> OL (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:I�11 4 rU�r iPe71 W(' PROPERTY TAX#: .9 8N 2y0U200i 00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION �L <br /> OWNER NAME: WC k 9D Irl 'VIG7� LL_G TENANT NAME(If Commercial): C C 1 Cr IC 1 1 W vOCS5 <br /> OWNER MAILING ADDRESS: STREET (J��`'yI <br /> CITY C([I Tl (. STATE WA ZIP v{�V <br /> OWNER PHONE: �A OWNER EMAIL: <br /> CONTRACTORNAME: I-\e of Sl Vl Ond, ve'A5in <br /> CONTRACTOR ADDRESS: STREET <br /> A2 6 C)8q{ S. , / vn�V- /� <br /> CITY I_1A,\I� 1n�1�1011STATE W A ZIP I 7 J <br /> CONTRACTOR PHONE: (360 1-17-'A- 137-!5 CONTRACTOR EMAIL: b1&On jP eWIP, ��51 h . 00.1 <br /> CONTRACTOR LICENSE#(REQUIRED): nIEJCR5A0'M()F I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �ozS�I <br /> PRIMARY CONTACT: O OWNER V CONTRACTOR O OTHER(Please Specify) <br /> CONTACT NAME: LCONTACTPHONE:CT EMAIL: S � nlec`" YVIC Cf Sl C) LdY7� <br /> 11 BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 5,000 <br /> Proposed Use of Building: i` Heat Source: o Gas o Electric O Other <br /> Building Type: O SFR-Detached O SFR-Attached O Duplex O Multi-Family-#of Units: Commercial O Industrial <br /> Type of Project: O New O Addition O Remodel O Repair O T.I. Sign O Sprinkler O Demolition O Change of Use <br /> DESCRIPTION OF WORK: <br /> I�nS�alltr�' 1 new MumiyAcAed Ckctirce Oaf- wall s18 v-). <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 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 /> Building Official before being authorized under any circumstance.1 am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> y PERMIT# <br /> I L ?- GC <br /> Owner/Authorized nt Signature Date (Revised 10/12/2015) <br /> I <br />