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PERMIT APPLICATION <br /> BUILDING / MECHANICAL / PLUMBING / SIGN / 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 'Nt C'' q g.2O8 PROPERTY TAX#: <br /> �Q�� � � �rlaP_c�,.��.�y. 09S156279000 <br /> LEGAL for new construction: Short Plat/subdivision Lot No, (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 3.1(n c4- TAN Y,4 ROMTENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET )0(p03 (30TI b12-1\) -- SE <br /> .Et/ens�(;t - SiTT_ ?rPa08 <br /> OWNER PHONE: OWNER EMAIL: VJ4, <br /> C <br /> CONTRACTOR NAME. oleNcR cT DNE /coF//�/(� INC. <br /> CONTRACTOR ADDRESS: STREET J7/,21 /t5 /gt yi iQ. 6'£,2 f-jo4 <br /> CITY (L1)rig I'LL STATE it/i4 'IPP 9S0/.Z. <br /> CONTRACTOR PHONE: /„26"-- _O/// CONTRACTOR EMAIL: 411-RA( CON &'7-0V RODc/NG.CGY7 <br /> CONTRACTOR LICENSE#(REOUIRED): CozyEA'Z-D11.Cn'7 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0336-6 <br /> PRIMARY CONTACT: ❑OWNER C>aKONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 1126-_�l '5_-D/l/ <br /> EARA c0QW/614, OFFICE 174N,4&ER CONTACT EMAIL: RAecoRAIERfg Ln/D2Q7F/NG.t:o/YJ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: A(&&p , Q Contract Price of Work: $ G 7.T.00 <br /> Proposed Use of Building: {CCT 11 Oc,yt. 4.49-7-)42--,->-.t2 Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: R'5FR-Detache SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair DTA. ❑Sign ❑Sprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> a‘ywA >i&v - -ct• 4AI Cl" opt <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 Fixtures List of Fixtures #°f List of Fixtures #°f 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.1 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 115.27 RCW and 296200A WAC <br /> City of Everett Official Use Only <br /> # <br /> P IT <br /> t,d�in.tsar <br /> /Q/7120 <br /> S Cp �� -- 0( �- <br /> Owner Authorized Agent Signature URevise 5 20/201 <br />