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0 PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN /SPRINKLER/ 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: / 315 7E-1R)2ACC PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> � j CONTACT INFORMATION <br /> C. IS <br /> OWNER NAME: ERII O fZD�IV TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET4315 TF-91; /ACE /� /y <br /> CITY v G K E t STATE WA ZIP 98 2 V-3 <br /> OWNER PHONE: *aG -2'rJ•8" � OWNER EMAIL: Pert coo eLft- lr of of c-51Ct�-1-. com <br /> CONTRACTOR NAME Of-W Hofzitpa 00S T L)C i A) Lt- C <br /> CONTRACTOR ADDRESS: srREET 27A� /-/CD I ff I Ss AV o S C <br /> CITY C N r STATE `/`I ZIP / V 0 Lf(� <br /> CONTRACTOR PHONE: LIZ 5 C CONTRACTOR EMAIL: 1J I c Eo/'—}1 — f C!,.&(a L Cor✓I <br /> CONTRACTOR LICENSE#(REQUIRED): N6WHOHC 86A'N8 ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED) l r <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER(Please Specify) <br /> I CONTACT NAME: V(CTo(Z CONTACT PHONE: Lf 2-S U <br /> CONTACT EMAIL: V jC &or- h 7>^C,a e L,Ve <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: P'&S t ptV CLQ Contract Price of Work: $ 6 500.UU <br /> Proposed Use of Building: Heat Source: ❑Gas Mlectric ❑Other <br /> Building Type: ❑SFR-Detached W§FR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel epair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition []Change of Use <br /> DESCRIPTION OF WORK: <br /> gow izcac/-C�wUM7' <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 I 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.l 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 gaj7ply wh the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> PERMIT# City of Everett Official Use Only <br /> ec <br /> Owner/Authorized Agent Signature Date (Revised 10/1212015) <br /> .r— <br />