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0 0 <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN /SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 4*77 3200 CEDAR STREET,EVERETT,WA 98201- <br /> (P) <br /> 8201-(P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/perriiits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1,411r7 Cyk4Nb AVE 7PROPERTY TAX#: 00-Y 7,5-3 Q96-008co <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: M Lf Ul A-F L WI-1 /7-,C TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET 191-7 6RANb AV5NL(E <br /> c,Ty )5Vr--kE-7-r STATE LJA- Z: <br /> �"FQG) <br /> OWNER PHONE: <br /> 1OWNER EMAIL: <br /> CONTRACTOR NAME: �0RtVEP-STZ*jE &PF//V&" //VC- <br /> CONTRACTOR ADDRESS: STREET 1'7&Q Ai 15*,\- di&nA, 6,6, 1*/0 <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: 1CONTRACTOR EMAIL: tSAsZ,4(2 C01QNj5A?,S7Z4Ve7Q0CF1jV6- CCV <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): OC336-4, <br /> PRIMARY CONTACT: El OWNER 2'CONTRACTOR 11 OTHER(Please Specify) <br /> CONTACT NAME: CR1,146 M/Clrz CONTACT PHONE: -20& 786 <br /> CONTACT EMAIL: (:4qA,I6 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 6-45%00 <br /> Proposed Use of Building: rr lHeat Source: 0Gas []Electric ElOther <br /> Building Type: DSFR-Detached EISFR-Attached []Duplex EJMulti-Family-#of Units: ElCommercial ED Industrial <br /> TypeofPro ject: E]New OAddition CRemodel EIRepair OT.l. OSign E]Sprinkler DDemolition []Change of Use <br /> DESCRIPTION OF WORK: <br /> IASSOCIATED 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 /> 4 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 Cleat 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 /> I Number of Heads <br /> ACKNOWLEDGEMENT:t 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 Linder 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 19.27 RCW and 296 200A WAG. <br /> City of Everett Official Use Only <br /> PERMIT <br /> Owner/Authorized Agent Signature Date (Revised 1011212015) <br />