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PERMIT APPLICATION <br /> 'IlPO4/Y;:::4 BUILDING/MECHANICAL/PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> y 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 INFORMATION <br /> PROJECT SITE ADDRESS:- cta i CT'F Q1.� piefott t::::- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision ision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: C VeYLLT7 0-1-4 fro C- TENANT NAME(If Commercial): eve/et-Tr- (2L.,,Jt C;,. <br /> OWNER MAILING ADDRESS: srmrttm �o/ uO/VTa r( <br /> art L�'14--)t` /fV STATE 64,044- zp 952.0/ <br /> OWNER PHONE: X125"-324—Lob Z-/ OWNER EMAIL: 4,z/7)1-00G-1/ -re-L-1A✓t c•- . cosi <br /> CONTRACTOR NAME: VI K(vV ro Au1`o.ua41 ( SAe,�KI YL.- Gc)444 'i 4/ <br /> CONTRACTOR ADDRESS: STREET 3`fes{3`I /=/f1s f /v1„-wi.t c= 4a�. <br /> Cm �6:11-777-&-.-- STATE UM- ZIP ?b13` <br /> CONTRACTOR PHONE: ?Q Co-&Z.%- el Co s.-(® CONTRACTOR EMAIL:46416.14‹a I o<( Yt.®V!k t irep y.",/!C Lca(see'r <br /> CONTRACTOR UCENSE#(REQUIRED):y1 K IN 4-S-37 3 AI t CITY OF EVERETT BUSINESS UCENSE#(REQUIRED}:O .4-1,0 9 <br /> PRIMARY CONTACT: 0 OWNER XCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: '?v(.,—(p as L_( (05"-00 <br /> Aw/ 3i c.t<u�f CONTACT EMAIL: QWit,ler;4 I GKt. 1t gpV I ki,J ",,,ki<tete. irr- <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: A)G,)2- 6 C.1"It C._ Contract Price of Work:$ 6,0 `e- <br /> Proposed Use of Building: Heat Source: ❑Gas tlElecfic ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: (Commercial ❑Industrial <br /> Type of Project ❑New ❑Addition ❑Remodel ❑Repair OT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: .p."),„Wi _ N <br /> tcpjsj 40uf3 Q N -'z- G h>4, 'tel C c.:4•. <br /> A.55 -r/3 Li (8�') <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 /> Fixtures List of Fixtures List of Fixtures List of Fixtures List of 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( By/Mop/etc.) Other <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> (Number of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and conform the informafion 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 veiling horn the <br /> BuDd6ug Official before being authorized under any circumstance.1 am the owner,orf am authorized by the owner of this property to peribrnr the work for Vlach appYication is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 298.200A WAC. <br /> City of Everett Official Use Only <br /> Z)s U ' il ,te-,M -. PERMIT# <br /> ilc 090-- 0 <br /> Owner/Autho ge ignature Date (Revised 10/12101 41, <br /> US—). <br /> ✓'CJI <br />