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PERMIT APPLICATION <br /> BUILDINIJ&ECHANICAL / PLUMBING / SIGN&RINKLER / 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: 1(00/1 qE W(T-r AVE FL OpK. 6 I PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �oleuEl.�c�S ST CL-4t2 TENANT NAME(If Commercial): LJI:SS <br /> OWNER MAILING ADDRESS: STREET <br /> CITY SrarE J zIP 6-70E36 <br /> OWNER PHONE: 2(>I-3S2-- 4(,S1 OWNER EMAIL: GOR7�lELtuS . STG(_AIfZ a� c�C�S• GOM <br /> CONTRACTOR NAME: 'SK-oT-pa.L 2e---L- <br /> CONTRACTOR <br /> t---LCONTRACTOR ADDRESS: STREET 270-7 C_C7Lr3Y A11E, <�71`-E 12DG <br /> CITY Ev-a R E T-T- STATE \-IA ZIP 9&201 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: IDAYE. 6 7,A F-e S KOTDAL . CC vN <br /> CONTRACTOR LICENSE#(REQUIRED): I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR OTHER(Please Specify) Q P—C N I Te c-r— <br /> CONTACT NAME: �-- �c SMRD�t CONTACT PHONE: 216 , 58t3• ®SCD <br /> CONTACTEMAIL: S-T�+t� rj(,ry�ppL e Y®co1•t. COM <br /> BUILDING PERMIT APPLICATION r <br /> Existing Use of Building: US(N£SS Contract Price of Work: $ LlJV7 <br /> Proposed Use of Building: gosl"(FSS Heat Source: ❑Gas El Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached El Duplex ❑Multi-Family-#of Units: ommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> //Fs(Oor6 pF �x t s r �.vCL 1 r t T�Ktc�2. C�F�cGf✓ S PQM O� T�-lt� (TH f �cc>m c 4nE <br /> 2 0 11 L n t N C-=, SC.JA E Ut= a,.�ovl.lC (>`i C L U DES {� (^'I Off--T«>nl 6F Esc!y rr...r Fi I w n5 rens(- <br /> �,6,/LT'tftC>P(S t C-1N(5LII:S } Ti-1E. Com Sr2u Lrrom c>r- <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 I 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 /> N�,®, INumber 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 State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> �— A p PERMIT# /}2 f <br /> Owner/Authorized Agent Signature Date (Revised 5/20/2016) <br />