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grr 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 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: a.s0L 2C�� JWC` PROPERTY TAX#: OO�I 3c1 1{2(p200I0I <br /> LEGAL for new construction: Short Plat/subdivision l Lot No. (attach copy of long legal description) A•1- ,4 <br /> CONTACT INFORMATION <br /> OWNER NAME: •J.e -cl LuAAC, Wt-tx:Q TENANT NAME(If Commercial): A d r ARiw;ot'1 <br /> OWNER MAILING ADDRESS: STREET <br /> t `3(;,iOZ ,`j2t.{ <br /> cu - <br /> L` U;L»/ <br /> ._ _ CITY LIN �rwoo('{ STATE T.,30-Cly ZIP 6 <br /> OWNER PHONE: L(2 `795pp- 2U3 G OWNER EMAIL: <br /> CONTRACTOR NAME: NC(i9. L rr).L. - <br /> CONTRACTOR ADDRESS: STREET `I(y is /uid ucLk AVL A) (y v <br /> CITY J-�.C1,Y-k STATE W�\ ZIP q D/(J 3 <br /> CONTRACTOR PHONE: ©(D - j " 95 70 CONTRACTORgqEMAIL: `Pc.)', LC> jy�y +� y y� (y�r��L�.�jbc.6,), <br /> R(j �C/-1 <br /> (L�v" <br /> CONTRACTOR LICENSE#(REQUIRED): 1V Oi 5 I 1 YO CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0/g)34-1._ <br /> PRIMARY CONTACT: 0 OWNER ErCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: D Z�� '�U�"� CONTACT PHONE: „2Q(p- - 9.570 ex-1 <br /> /j c <br /> CONTACT EMAIL: SCI Gtj (nb(?Jt. <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ .3,LI S 7, <br /> Proposed Use of Building: Heat Source: L"Gas OE-lectric__,// ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: O'6ommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel Er-Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> u)(A:t a z ;ryas I u- i-o I teak, <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 #°f List of Fixtures #°f 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/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 /> ? Li ((, 1X04. 'D(PD <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />