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PERMIT APPLICATION <br /> BUILDING / ECHANICAL I PLUMBING / SIGN I KLER / 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 wwweverettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION n/� <br /> PROJECT SITE ADDRESS:22(j 1 Qk P1ac� 34 EVee# ,lith�'LZ03 PROPERTY TAX#:OO(p63 00000 1-7 <br /> 00 <br /> LEGAL for new construction: Short Plallsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> r <br /> OWNER NAME: W j id4 C i I Man TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2.2(p "IL ?Ott SVS( <br /> CITY Evfit sr.,. ZIP 981 '" <br /> OWNER PHONE:`U/2S 31-i3'612.- OWNER EMAIL: ,11ci O n n a oi-m O t l • Co m <br /> CONTRACTOR NAME. co eNcR cSTDA1E IQcOF/A Ai G., /NC <br /> CONTRACTOR ADDRESS: STREET 176.2174 /5 ' - ,}tre,y- ce 1o)4 <br /> (.:IT,, cC]L/T—HELL STATE /OA- :'I t' 9 fD/4Z. <br /> CONTRACTOR PHONE: f 5 _-y8S-Q/// CONTRACTOR EMAIL: /2/0 c IV e67Z7/VE/?Xf/A/G.CO/)) <br /> CONTRACTOR LICENSE#(REUUiREDi: COR/V, >Q v.2j.Ciy') CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0335G <br /> PRIMARY CONTACT: ❑ OWNER rii<ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> 14 _ �y -y85--o/// <br /> SI RA GOA/16 OFOCE m4N14&FR CONTACT EMAIL:,sARA.e A, &.c0/9,9 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building:Slr9K ¶ m% 3 ReSid•CnCt. Contract Price of Work: $7-550 . 00 <br /> Proposed Use off,B�B/uilding:Singvt familt g.esiden.ce Heat Source: Chas ❑Electric DOther <br /> Building Type: tiSFR-Detached ❑SFR-Attached ❑Duplex i Multi-Family-#of Units._ ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition DRemodel ii +epai i .I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Remove e xi3IIc\e layer of c,ormv and replace wi+h ( orl"W' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> • <br /> MECHANICAL PERMIT APPLICATIONPLUMBING PERMIT APPLICATION •• <br /> Type of Project: New Addn Alteration _Repair Type of Project: New _Addn Alteration _ Repair •• <br /> #of • <br /> 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 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.L Other: <br /> SPRINKLER I 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 Slate Contractors Law 18.27 RCW and 296 200A WAC <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Owner Authorized Agent Signature Date (Revised 5120:201E) <br />