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RE�E� (e) y �`�" 1.)o �N)LeOLT Pr <br /> PERMIT APPLICATIO <br /> BUILDING/MECHANICAL/ PLUMBING/SIGN/SPRINKLER/ 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 /> (Blue or BIack;ln(rOMy (Osie),_d,,,, ROJECKSITEJNPORMATION _ <br /> PROJECT SITE ADDRESS: 1 S32 Eti# 'gvitmm 0.414rPROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision ( of No. (attach copy of long legal description) <br /> >v � n ON'tA� TION } p 3� <br /> � � .�^•�ii• �I�,TS'_"'r!'.'!'�.. ,ti, .„�_44k .`9t,�,.E;_ arm,_.•* a� e��=v. ..�,r" "'" " <br /> OWNER NAME: TENANT NAME(If Commercial): WUIL •-•i ga <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ALV I r•3E 1'1 2 E <br /> CONTRACTOR ADDRESS:,SS STREET ci\�k AO6r� NOE <br /> CITY e_t_,N. .Jt cr N : STATE ZIP 98233 <br /> CONTRACTOR PHONE: 0•15S '5yyCONTRACTOR, EMAIL: s�0(re.�._0 (3Apn itrc,cor-) <br /> CONTRACTOR LICENSE#(REQUIRED): `�INFS 0-7"1 le-U CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ,CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 3(oO <br /> 1 )kSik'Ac CONTACT EMAIL: S fl O alNer\ec'r{c-Coin <br /> r �' '. . .- BUIL:DINGfi E LTAPPLICATION . <br /> Existing Use of Building: Contract Price of Work:$ 500 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ..Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel V8epair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: `S`otv _IT) (6) F�,e_e rjapeIc SSS toi S‘. s-t"nr, <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 /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> 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 /> SPRII�IKLER%SUPPRESSION SYSTEM`.""f <br /> (Chemical or Water I INo.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 I 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 296.200A WAC. <br /> City of Everett Official Use Only <br /> / I 6/26 PERMIT#1/ s07 -001 <br /> Owner/• • horized Agent Signet re ate (Revised 9/23/2016) <br />