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PERMIT APPLICATION <br /> #11.*�/� BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> 411111 (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: (001 5E ekkict1. I Itr-i PROP TY TAX#:Ha <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION A, <br /> OWNER NAME: IV (j �k tAigtic` i 7 1 TENANT NAME(If Commercial): 14661104 Mf krt cr <br /> �,j[[ <br /> OWNER MAILING ADDRESS: STREET 1 U ( Z' — /F- . l <br /> city' T-r V Ji _ STATE I.L k ZIP q�3`-'(� <br /> OWNER PHONE (P64 63‘1 OWNER EMAIL: ))))1111 / <br /> CONTRACTOR NAME: SG't ii,to A\--V.60 q7,OS 6 <br /> CONTRACTOR ADDRESS: STREET 3cfjl I5j tti <br /> kvE 2.ct <br /> CITY l 3 STATE k ZIP ci yle <br /> CONTRACTOR PHONE: ( 4-613-- H57 -(1tlO I CONTRACTOR EMAIL: SC%i CCS G 1(6,5 4(A IOr),co i'Cl <br /> CONTRACTOR LICENSE#(REQUIRED) --(641,,,( $I-kJ 0 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) ((O3-W6 <br /> PRIMARY CONTACT: ,DOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: I i CONTACT PHONE: - y 43i 3 <br /> Mak ;; al . "ff P CONTACT EMAIL: pid1/lv►r- hr YU. ,f.CORM <br /> BUILDING PERMIT APPLICATION <br /> ---Th <br /> Existing Use of Building: \1/412.2.A. Contract Price of Wor :$ 7c <br /> Proposed Use of Building: 1 2g-Lk Heat Source: ❑Gas • ectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: .-Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition laRemodel ❑Repair ❑T.I. C3Sign ❑Sprinkler DI Demolition ❑Change of Use <br /> s ESCRIPTION OF WORK: ' . G. . - <br /> ,\ • ' • y44©NQS U,t r .. Ct"°apt` fov1 W <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 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.I am the owner,or I em authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with - -te'rectors Law 18.27 RCW and 296.200A WAC. / <br /> . City of Everett Official Use Only <br /> , ' ' (96/*Ific-1) PERMIT# <br /> Owner/Authorized Agent Signature Da (Revised 10/12/2015) <br />