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PERMIT APPLICA I+81V <br /> VA <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 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everetlwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: c-106-,-, f ET EV,8,re-f-j- M a(} I-t ,#U/",LLJ N (PROPERTY TAX#: <br /> LEGAL for new construction: Short Platlsubdivision ltJ f <br /> Lot No. (attach copy of long legal description) <br /> _1tCONTACT INFORMATION <br /> 'P$ <br /> OWNER NAME: ir- c� I4 ,���f I�t(y LiilTENANT NAME(If Commercial): nj Fa GYv <br /> OWNER MAILING ADDRESS: STREET &e j 111 104 St )p <br /> CITY SeLL I T I e-1 STATE /V/,4 zip I� <br /> OWNER PHONE: 111 'OWNER EMAIL: <br /> CONTRACTOR NAME: .5;i L) .F� ext.,e , Plat_.f! i o�d /4 1-1-624-irk--k( Ik <br /> CONTRACTOR ADDRESS: STREET 11T75 .Si 1 Ver4Ya-(e_.u)ail, tik I�(.JI i - :1t <br /> L/ <br /> cnY5t (Ik' G�lr°,. STATE' (14 zie 1 U 3 <br /> CONTRACTOR PHONE:-34.. 4f,,q,:). _.w 'CONTRACTOR EMAIL:[6/-25)&, 11 v �aLe1ii iii �L4,-) <br /> CONTRACTOR LICENSE#(REQUIRED): <br /> S )�YI )._,)_LjtaI CITY OF EVERETT BUSINESS LICENSE#{REt]111RED): <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:� 3epe) 4,74,,;...... `,/ <br /> tlr- 'ke.:,1 11 <br /> je/')I') CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building:"I- i I,{J pr . Contract Price of Work: $ 3'x01)- (Y) <br /> Proposed Use of Building: 7--1 (,ci on- Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: filCommerciai ['Industrial <br /> Type of Project: ONew ['Addition ['Remodel ['Repair VZT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> rurnis6l ( iei5-f!Ll( (J1/'U'aii,,'Y --i)(--( tre3 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 6 )4,,,,,_3-G <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New — Addn Alteration __Repair Type of Project: New Addn Alteration _Repair <br /> #of #of #of <br /> Fixtures List of Fixtures List of Fixtures List°fFixtures #of <br /> Fixtures Fixtures Fixtures List of Fixtures <br /> A/C-Air Handling Units Heat Pump -i Toilet <br /> Forced Air Systems Unit Heater Backflow Preventer(Inside Bldg) <br /> —Bathtub —Urinal <br /> Gas Piping Boiler -'Lavato Wash <br /> Water Heater Basin) FloorDDrain Fountain <br /> Refrigeration Shower �- <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting -Dishwasher <br /> Clothes Dryer Hookups Other: -Roof Drains <br /> —Clothes Washer —Medical Gas <br /> Range Hood -'Water Heater —Other: <br /> Exhaust Fan EMU Sink Service/Bar/Mo./etc. _Other: <br /> SPRINKLER/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 he authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or I am authonzed by the owner of this property to perform the work for which application is made, <br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> IaPERMIT#we.,.. N-kly&u,4, , —7 'I Li-4, <br /> 1 <br /> (Revised <br /> Agent Signature Date 5i20/2016) <br />