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PERMIT APPLICATIOki <br /> BUILDING / MECHANICAL I PLUMBING /SIGN 1 UrRINKLER I DEMOLITION <br /> '11.(eYP---:‘ <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE:IN:FORM¢1T1®N <br /> PROJECT SITE ADDRESS: 23 t.,.tol.t PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> :CONTACT INFORMATION <br /> OWNER NAME: bo.l t ttlCL' TENANT NAME(If Commercial): Imo, sm+, Q1�C <br /> lC <br /> OWNER MAILING ADDRESS: STREET 212.3 }{0,0. .4.a <br /> cm! �v.e STATE \.LiIA ZIP /P,2.0 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: fk[at- soA /VLeC-tel cw.1CcJI :�v�• <br /> CONTRACTOR ADDRESS: STREET t220 N.,, , 6„, kr.n . <br /> CITY Sh,,,int., sI, STATE l...-At ZIP 9 S 2'2() <br /> CONTRACTOR PHONE: c2.S—So',`ISO s CONTRACTOR EMAIL: ,S� ,yt,n ?k.tc'^r'iSc,"v"` t"c,w:cctliA(.Co1.., <br /> CONTRACTOR LICENSE#(REQUIRED):}{/}Z.f2"I�i=293 c,L_i_ CITY`OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 18 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Ll 25.-SUg— 1S0 <br /> , C`rs,.�4 14 nsG a,.A CONTACT EMAIL: 3A5 0 kc7-r-n.sw, ec.1,6:r.;c_4 '. c-,`ti <br /> : BU.ILDLNG-PERMIT APPLICATION. <br /> Existing Use of Building: <br /> Contract Price of Work:$ P-f,5eo-cam' <br /> Proposed Use of Building: Heat Source: ❑Gas 0-Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: gCommercial ❑Industrial <br /> Type of Project: DNew DAddition FIRemodel ORepair DTI. DSign I:Sprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> .. �th. 2 �er-'t-1 v u v... i s s' c.,...cd 3 v.1)--- e_x(n of "€e.u.g <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION;`: <br /> PLUMBING OP:Ognot APPLICATION. <br /> Type of Project: __New Addn x Alteration Repair Type of Project: _New _Addn Alteration _Repair <br /> #of #of #of List of Fixtures <br /> List of Fixtures #of List of Fixtures List of Fixtures Fixtures <br /> Fixtures Fixtures Fixtures <br /> NC—Air Handling Units 40 Z 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 /> 3 Exhaust Fan I Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPP:RESSION 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,ori 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. City of Everett Official Use Only <br /> 5/2.0/t66 #/(/( ��c 5—. obs <br /> Owne thorized Agent Signature Date (Revised 10/12/2015) <br />