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PERMIT APPLICATION <br /> BUILDING . :::;CHANICAL / PLUMBING /SIGN /Si nuNKLER / DEMOLITION <br /> 4010/ . <br /> 10 ,.3 -1. CITY OF EVERETT PERMIT SERVICES <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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: }$k%) Si tZI 0 PROPERTY TAX#: <br /> LEGAL for new construction: ShorttPlatlsubdivisioli Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 13 r I til AkSolei;l TENANT NAME(If Commercial); <br /> OWNER MAILING ADDRESS: STREET 13 lQj 311 S"--- l'�1 Co <br /> CITY STATE lAilifZIP 9 24:0 I <br /> OWNER PHONE: 2 "4-G' (::?A(.4$0 !OWNER EMAIL: <br /> CONTRACTOR NAME: Ps),`), C°\C Col y ' <br /> CONTRACTOR ADDRESS: STREET /L t'� Li 1 .t <br /> j y �j�����IJnr <br /> crry t( 0 V4471.-1 ZIP CiL o I <br /> "'- STATE G <br /> CONTRACTOR PHONE: , Gam( C J CONTRACTOR EMAIL: )14' ,,g`1-661)C.1,Y(,,t.� c , , -t <br /> CONTRACTOR LICENSE#(REQUIRED): (1....0 ...i+l..a.‘ Y '2`... CITY OF EVERETT BUSINESS LICENSE#(REQUIRE : s, <br /> PRIMARY CONTACT: 0 OWNER 4, CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: !~ CONTACT PHONE: LOC <br /> CONTACT EMAIL:t• yte,#�."� a P )(W`t 4 -o, .f Co(Y-N <br /> BUILDING PERMIT APPLICATION % <br /> Existing Use of Building: Contract Price of Work: ' 2-a e) m <br /> r <br /> Proposed Use of Building: Heat Source: *Gas ❑E�t ` ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> jpe of Project: ❑New ❑Addition ❑Remodel 'Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ? QLJkce1 6 - <br /> CØoVflASSOCIATED BUILDING PERMIT#(if applicable): � �l �� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn __Alteration —oRepalr Type of Project: _New _Addn _Alteration Repair <br /> if of List of Fixtures #of #of <br /> Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures List of Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> I 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 g 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 /> CKNOWLEDGEMENT: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 /> :urrent 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 /> 3uilding 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 /> Ind I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> } <br /> City of Everett Official Use Only <br /> 1 ete ; , ,` " l-lZ- 1 -- niA,...4.0 <br /> C - 0� Co <br /> )wnr#/Authorized Agent Signature Date (Revised 9/2312016) <br />