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• PERMIT APPLICATION • <br /> /111P41`1.//-----A BUILDING /MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES (I(b D -070 <br /> 3200 CEDAR STREET,EVERETT,WA 98201 oZ3 �j <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 19s cep/42�- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION 1' <br /> OWNER NAME: M A(Z IC.. COLA-(fel- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 19 S5 CEC )/ (2 ' 1 qq <br /> CITY &i v �_ STATE u)/: . ZIP �.l8 20 I <br /> OWNER PHONE: 425- 829 • 499Co OWNER EMAIL: ('--1A(Z4C01-1_lS(oOSe .COI"( <br /> CONTRACTOR NAME: L SEe- C2-00c((',E CO - (( 1G- <br /> CONTRACTOR ADDRESS: STREET P 0- BO) 31249 <br /> CITY PO /P LL OP STATE L•DP. ZIP 98 a 1 <br /> '7 <br /> CONTRACTOR PHONE: '2-SS - 54S -3(9-1 CONTRACTOR EMAIL: S4-1"e62-42A L .0 1 <br /> CONTRACTOR LICENSE#(REQUIRED):LEG"i l(2C 9e4 DK( CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0460238 <br /> PRIMARY CONTACT: ❑OWNER Er-CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2t(- 255 - 9152 <br /> DA'J G. k-► I2 CONTACT EMAIL: 2, 'J- - <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: RIS t Contract Price of Work:$ <1 i 5000.`Z7 <br /> Proposed Use of Building: Heat Source: El Gas ❑Electric ❑Other <br /> Building Type: CESFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel C'Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: - Z <br /> Q- Lc0/ C-cr:)t--te tzlot3 t�Eal d� <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 /> AIC-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 /> I 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 lam 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 /> PERMIT# <br /> 2-7? S( (too a -o_i0 <br /> -uthorized A ent Date (Revised 10/12/2015) <br />