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41677- PERMIT APPLICATION <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 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS://t3 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plats dlvi on J ) V\6-1j <br /> Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Y(n' A I)ekl TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET '-0e of-7)4y jotArt S 0 <br /> CITY LAkkr t- VCk / STATE t/ ZIP 9 U 4,47 8 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: f- kokt MooS-& Til[- <br /> CONTRACTOR <br /> CONTRACTOR ADDRESS: STREET /'�J�(7 .---6,,! 4 W <br /> CITY a/MOV1'( STATE 6.)4 ZIP t9 Oe)>6 <br /> CONTRACTOR PHONE: 4L 34•-191PC CONTRACTOR EMAIL S{ 5r5 Ec /Q CAo j.e Grp/vt <br /> CONTRACTOR LICENSE#(REQUIRED):,Li4r/'4MZ'._f L5' CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CbLt 001 <br /> PRIMARY CONTACT: 0 OWNER trOONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 44). -TU •-9.2 4 v <br /> &10 74V-k CONTACT EMAIL: 11n,5tec'�`-t-k !4`2w,ia Le)-)-1 <br /> BUILDING PERMIT APPLICATION \\ �� <br /> Existing Use of Building: Contract Price of Work:$ ---4-„,,0 <br /> Proposed Use of Building: Heat Source: &Gas 0 Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached 0 Duplex DMulti-Family-#of Units: (2tommercial ❑Industrial <br /> Type of Project: ❑New DAddition ItRemodel El Repair ❑T.I. ❑Sign DSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: �� <br /> ��-�r""��� G�;t-7-Nt-S ekv► 'in St"I/ )w,..) 7Q-was <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 /> • <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 /> 7 -Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> y Exhaust Fan Sink(Service/Bar/Mop/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 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# <br /> �- /i1/1 1512-' °Li u <br /> Owner/A •r¢-• •-,z Signature Date (Revised 10/12/2015) <br /> 1 <br /> Z-- <br />