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PERMIT APPLICATIO <br /> BUILDIIWk--! MECHANICAL/ PLUMBING / SIGN ) SPRINKLER/ 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 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 4 (t5 C&N t jlZ PL PROPERTY TAX#: DLL&Oli>LfOc7OOj2t 0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: M iLi+AEL c DjAI,yG k c&pZwE IX TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 4 I (!CWTF-?- PL l <br /> CITY C STATE tl.'iE ZIP C1 19 ZL,3 <br /> OWNER PHONE: 'J26- %-T(,-0(63 OWNER EMAIL: Wl k'Kites nt'P cu6Y\cc15t,r\eE <br /> CONTRACTORNAME: A--F(=( LLC. <br /> CONTRACTOR ADDRESS: STREET 4 p 4 G 34'I`�4 A'UGt% <br /> CITY st t AT t-e tt A q 0 p( 19 STATE ZIP <br /> CONTRACTOR PHONE: 9-0/✓- 2-!j q -- b i Lb CONTRACTOR EMAIL: gs 02 <br /> CONTRACTOR LICENSE#(REQUIRED): A 1-e j )(L * b t S kS' CITY OF EVERETT BUSINESS LICENSE#(R QUI ): <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2tcc z&4 -6,2 2-L <br /> -$R utE SC'14t,&NftA 1I CONTACT EMAIL: 3, e <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: SIP?, Contract Price ofWork:$ <br /> Proposed Use of Building: 5/VAE Heat Source: MGas ❑Electric ❑Other <br /> Building Type: XSFR-Detached ❑SFR-Attached []Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: i ULUN.TAe-j S6-)SpKjG P-L-'r(ZLFIT of A FAtht,tr_V P-6SIUt5�'VCE <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 /> Chemical or Water I No.of Heads <br /> ACKNOWLEDGEMENT:/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./am the owner,or l am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 419117 1 pct" ®✓�Z� <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> ci� <br />