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PERMIT APPLICATION "111141/S ----1BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ DEMOLITION 4CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 l(E)everetteps@everettwa.gov I wvw.everettwa.gov/permits PROJECT SITE INFORMATION ; PROJECT ADDRESS' PROPERTY TAX#: 4/3?iv? 1 „Z�CTSIE � 9 0 I ,( �Q LEGAL for new construction: S rt Plat/subdivision Lot No. (attach copy of long legal description) .CONTACT INFORMATION OWNER NAME: j.tF-C `j,l..‘‘`..., TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1.b O1%- 3�P 't L SE CIJ� Q Zv'1 TY l C v STATE WF, ZIP 1 84[21 OWNER PHONE: JLX - 4h2 2 V 331 OWNER EMAIL: %16-0is,—)-1-)1L .A.1%A i-, '. 0,IN L •CS3"'N.-- CONTRACTOR NAME: ,or)td,'W.,— CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BU: PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑ OTHER(Please Specify) U - f_)t) CONTACT NAME: CONTACT PHONE: Ailgi CA4HZ U U CONTACT EMAIL: 6 $ 7_4,0 - it0 BUILDING'PERMIT APPLICATION Existing Use of Building: srit_ Contract Price of Work: $ 14/2-n b• �Q� Proposed Use of Building: Sf e Heat Source: ❑Gas 4lectric ❑Other Building Type: 1rR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project: ONew DAddition Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Tact Po,1 .41r16 sepi.- A E/ ,(Lc-Ie ogc- wo4SE - d c STA-A-5 .712 6AR.AGF 206F A) /4177- A• /4177- WT A .A re mew C6/a j6'7-.5 ASSOCIATED BUILDING PERMIT#(if applicable): 1ie L� '' . A, W )11y tw MECHANICAL PERMIT APPLICATIONPLUMBING PERMIT APPLICATION Type of Project: _New — Addn _Alteration Repair Type of Project: New _Addn Alteration Repair #of List of Fixtures #of List of Fixtures #°f List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C—Air Handling Units Heat Pump C Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain _Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove f Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood / Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER I.SUPPRESSION SYSTEM Number of Heads — 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 current federal,state,and local law. T,- 'ranting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the Building Official before being autho zed nder 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, and I comply with the State Contr.ctor•Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only /1,_r e Owne •uthxyd Agee-� ,to PERMIT# late (Revised 10/2015)