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• PERMIT APPLICATION 0 <br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION / <br /> /4P/OZ/—/--A CITY OF EVERETT PERMIT SERVICES &1 t 0.. —07 1 <br /> 3200 CEDAR STREET,EVERETT,WA 98201 a ,-z3,..% h <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: 1933 Grp/412..„G_r PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: MAf2-t - COL-L-INI.a.. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 19 a 5CI DA2- GT �/ <br /> CIN F V -r- STATE LOP• qq ZIP c.i S 2-/ I <br /> OWNERPHONE: 42S• 829 - 4-99&2 OWNER EMAIL; t-IA(ZILC•OLI-(N1SCODSe'A(,4 O-�I"1 <br /> CONTRACTOR NAME: (..E-6eN I-200c l NG CO . t NG. <br /> CONTRACTOR ADDRESS: STREET PO. POS•�X ---1 3 I'24 9 <br /> CIN 7 <br /> PUPP LL OP STATE LIDP. ZIP 98 3-1a <br /> CONTRACTOR PHONE: 253 - 5.4e .3 19-I CONTRACTOR EMAIL: 04-1 212-1. (LI✓ E`1PSC .CSM <br /> CONTRACTOR LICENSE#(REQUIRED):LEE'tit2C984Dt4 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O46'Z38 <br /> % <br /> PRIMARY CONTACT: OWNER rrCONTRACTOR 0 OTHER �',< <br /> (Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 'ZOC,- 26G - 9"I9 Z <br /> DA'J t-1—2t✓( .) CONTACT EMAIL: 2A��C- L.E * •LZ)I'"I <br /> BUILDING PERMIT APPLICATION . <br /> Existing Use of Building: t C Contract Price of Work:$ t I, .36'0- <br /> Proposed Use of Building: 0p.t"tHeat Source: ❑Gas DElectric ❑Other <br /> Building Type: El/SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial [Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel Plaepair . ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: - 2-C:If==1= , 1: G1-1- <br /> . sifi---A6) f.2e.. _Cit: GO/ CC*-4F:Z: CriCDt•-) 1---1 tt,-) L-1 ---' <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 /> NC—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.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 /> PERMIT# /� / r 0 ?' - 0 -1 <br /> ^ 0 -1 I <br /> • . ,uthorized A ent Date (Revised 10/12/2015) <br />