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row <br /> PERMIT APPLICATIO <br /> BUILDING / MECHANICAL / PLUMBING / SIGN /SPRINKLER / DEMOLITION <br /> /1Poteg CITY OF EVERETT PERMIT SERVICES <br /> Niritl- <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 /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 31°C & 01/4_, v PROPERTY TAX#: bC76,0 S L`>oSCc Sp C> <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �vE.ce j 'O've,ki\ck. TENANT NAME(If Commercial): its,ty, rad f <br /> raLR <br /> OWNER MAILING ADDRESS: STREET 39!00 >31D <br /> CITY S qQA tk1p\ STATE ,db ZIP 9Z ff. \ <br /> OWNER PHONE: 1-/.(- - -3C - /a/ OWNER EMAIL: le�`.tkS loa a,\Io((IAe- ) �(; <br /> CONTRACTOR NAME: ('(LCi. ( 'KV 0! it S-IY0U V v , <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: II <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): L��L� "/ <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ,OTHER(Please Specify) b.,cL S O. <br /> CONTACT NAME: CONTACT PHONE: I - — 3 1/„ <br /> _- ' \ � � <br /> k_ CONTACT EMAIL: � /� ��(/1 -4,NA4 lAl.� <br /> BUILDING PERMIT APPLICATION �'` <br /> Existing Use of Building: t'c Contract Price of Work: $ (/0,I)Oe:D <br /> Proposed Use of Building: Heat Source: ❑Gas ®.Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: $Commercial 0 Industrial <br /> Type of Project: Pi-New ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ► k_l Co q r 432.....i / xxc_1 e 4 tc,,,,1/4.4 ?c,c..I '\^'a ) <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PEIRMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration Repair Type of Project: New Addn _Alteration Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> 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 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 /> •• <br /> j • Z 4 6 PERMIT# I r(D 3-00 Lf <br /> „Owner . th•rize A ent Signature Date (Revised 10/12/2015) <br /> ~ 'Z- <br />