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471"7- PERMIT APPLICATIOF, <br /> BUILDINU I MECHANICAL/ PLUMBING /SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJI O SITE,A'DDRISk k L n � PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> ` <br /> OWNER NAME: Ce o W1 1lDia, L, TENANT NAME(If Commercial): S <br /> OWNER MAILING ADDRESS: STREET * <br /> 9 ' Cd fK e -/ i/( - <br /> CITY .J!�SSc J V( STATE L ZIP 9570,-).7 <br /> OWNER PHONE: 42 53 I j +'�J� V n OWNER EMAIL: 'TPi'11 1,311,30 C:s�-r v . C d:7 OA <br /> (' <br /> CONTRACTOR NAME: QE-yV"`c Ci:cA)J(CicL- co , <br /> CONTRACTOR ADDRESS: STREET ( 7t F- (`6' A S <br /> CITY K e4--t- STATE 11"-- ZIP 1 8 00 5. <br /> CONTRACTOR PHONE: 2.53 -7Z. 73"/ Z CONTRACTOR EMAIL: `(j L_co 2404__s_-S 4) Kay(A ecctdvtf ?/ec <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTACT: ❑ OWNER 'CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: y CONTACT PHONE: G S-3 s'72_7 55,2_ <br /> ( l I Zo 2Azzs CONTACT EMAIL: •es,21:34"2-A.) KL y/"t e—C.(?)d,4-I,Cal v n. <br /> BUILDING PERMIT APPLICATION RR <br /> Existing Use of Building: Contract Price of Work:$ '756 . UW) <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> C k uky _ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> I ��� s1A �s I <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 al... Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood I 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 /> ,City <br /> — o1. : <br /> Owner/Author zed Agent Signature ) Date (Revised 10/12/2015) <br /> 1`Z <br />