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4E17PERMIT APPLICATIC <br /> BUILDING /MECHANICAL I PLUMBING /SIGN /SPRINKLER I 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.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INF RMATION <br /> PROJECT SITE ADDRESS:(14l 4 , W U PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: LOU-IAA/1 CAVE_ �(,� �r� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> /��7'//y PJ):°VERY 'L-V9 r'(r <br /> CITY /r-.vEkerf- �,STTA+TTE�Wim, may, ZIP T <br /> OWNER PHONE: U-05)?63--- $� OWNER EMAIL: eo--e.r4 ®- t�l,F,�,Com( <br /> CONTRACTOR NAME: /1/1Z,, I O PG{A r r <br /> CONTRACTOR ADDRESS: STREET p2, S,0.3.i. f ,,\ <br /> city 5 7(-irSTATE 4/k ZIP J 57/6 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): AVFM/r1247Ral, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):WM. a <br /> PRIMARY CONTACT: ❑ OWNER )$CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (X6) 7-6--46C.-55i <br /> L 2y jUia CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas El Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> D`y G SCRRIPTIONOFWORK: <br /> . /E `ce Q- F›<($77/.40:- ,5 U?— /_A Ete,A(- CA Jn W/�r�/c). G Y Vft"1 , <br /> . <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 /> A/C—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 X' Other: t p_(...pc-F.04.- <br /> Exhaust <br /> ...pc- 4L <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: Oa/- <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 /> ' Al <br /> I 1 I, (00?.ktbfb <br /> Owner Au orize• •gent Signature vct <br /> Date (Revised 5/20/2016) � <br />