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PERMIT APPLICATION .- <br /> BUILDING / MECHANICAL / PLUMBING /SIGN )80-kINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I wvvw.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2-2-6r) PROPERTY TAX#: 00q s° \LA1 4 061 o f <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: L2U 5 tCwdLAjcv �&A),cc L,LC. TENANT <br /> 1 NAME(if Commercial): v\AAt� 1 C ✓7 <br /> OWNER MAILING ADDRESS: -REET('� C, ( y '`1 C. eaGt ,5 (6� -�O'X bev'Avyxent D BOX ,Jq <br /> CITY L'r C�(� STATE - zIP o()15 <br /> OWNER PHONE: OW NER EMAIL: <br /> CONTRACTOR NAME: 1"\e .( SI( � ytCl VC(A'Sil y ' <br /> CONTRACTOR ADDRESS: STREET Z(oO$ W CI S. <br /> err„ \Je-friovi STATE W A zip 016Z 7 3 <br /> CONTRACTOR PHONE: 2J� qZLI- \3Z5COtNTRACTOR EMAIL: S PrS' h <br /> e VlIe @ V1Ae i .COvh <br /> CONTRACTOR LICENSE#(REQUIRED): h'�E`(C�SAO" (� G CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 22503q <br /> PRIMARY CONTACT: ❑ OWNER LICONTRACTOR ❑OTHER(Please Specify) 2 <br /> CONTAC(T,NAME: i 1 CONTACT PHONE: 0366) q'Z L1 - 1325 <br /> ��e�(�iV11e 1..1✓1�CI(J1c5 CONTACT EMAIL: t C�'%S�C�GY►le C IVIG c'+'SIC' ) 1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building. \ C� Y'PEM� Contract Price of Work:$ (.. <br /> Proposed Use of Building: mri S Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached []Duplex ❑Multi-Family-#of Units: ElCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK -1 <br /> )n966-vi, D1vmlyi �edT I—CO CkCnne� Otcr 5eis civxcl 2 Mvvl.'tr1Q4eo( inda-,,- <br /> vActv�9t►� vU�indow 5ic�h5 aln� no lluv�trr,ti��(%/ Crlve ��ry l,�rdge <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 /> #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 lKitchen 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 1 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 /> 1 C� City of Everett Official Use Only <br /> \) PERMIT#G(w -� <br /> cc4ner/Authorized Age 10ignature Date f (Revised 10/12/2015) <br /> 1 /.2 <br />