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PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING/SIGN /SPRINKLER I' DEMOLITION <br /> '1,—:‘ CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 1(E)everefteps@everettwa,gov 1 www,everettwa.gov,ipermits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS 56 q do/6 Ave_y A PROPERTY TAX#: D 4,4439 = <br /> 08 <br /> LEGAL for new construction: Snort Pla Jsubdivision Lot No, (attach cony of long!egal descripffor) <br /> CONTACT INFORMATION _ <br /> OWNER NAME: Q LLQ.' Sia,r C,re_ci f- 114l Olt TENANT NAME(If Commercial): 5&M ,e.- <br /> OWNER MAILING ADDRESS: sra_F-�ry��ID D1r 6 o x 94. 73.0 <br /> CITY IJ e l I e-✓tt&e. STATE 63 0_, DE'9 9)O`5/� <br /> OWNER PHONE: OWNER EfMAIL: F j� <br /> CONTRACTOR NAMEI O kt. 0n 1----e_aim 4 V.. E" 5ht�efi etel-K , rt C., — <br /> 1 <br /> CONTRACTOR ADDRESS: STaEE P O 7S'8 a A 13 t31 A.-v c npl t _ <br /> cTv L0. kG Std✓tMS STATE Lei j :P9 d.5''8' <br /> CONTRACTOR PHONE: a5-335 ` Li „lb 7 CONTRACTOR EMAIL: ti` '` o A t (P j a-)4,. -er,E67l <br /> CONTRACTOR LICENSE#(REQUIRED): R 1 C H t I M l R8 C� CITY OF EVEREiQ {� 1'�'_Il,t- VL BUSINESS LICENSE#(REUIRED):Q"3 9 4, 1 10. <br /> PRIMARY CONTACT: 0 OWNER XCONTRACTOR 0 OTHER(Please Specify) t 7 <br /> CONTACTTNAME: CONTACT PHONE: ii a,Ste-33 s'' tial 7 <br /> 3 e-0.N I Q- 6 R0.Ve S CONTACT EMAIL: r j tonkeotch' p/'Mf,G✓;C.,w <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: CAD N7`M C!`t,`.,V 0� Contract Price of Work: $ 5-9 D d <br /> Proposed Use of Building:!✓D M NLG;r'GI el ( T 1) Heat Source: ❑Gas XElectric ❑Other__ <br /> Building Type: ❑SFR-Detached ❑SFR-Attached 0 Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition l ❑Remodel ❑Repair VT.I. ❑Sign El Sprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1 e.Xk . PA. N(. ' d„L -h w 0 t2 K , R 6 's d.�e 1^,t,b <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 _Adds _Alteration Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> A/C—Alt'Handling Units Hes:Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boller Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trao <br /> Gas Range j p Ducting Dishwasher —Roof Drains! <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood L Water Heater Other: <br /> y Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: _ <br /> SPRINKLER I 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 ROW and 296,200A WAC. <br /> City of Everett Official Use Only <br /> Cliall4P-113..,/ 1-a g- I° PEri i (`� r- r(, I <br /> 1r/Authorized Agent Signature Date (Revised 10/12/2015) <br />