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PERMIT APPLICATION• <br /> BUILDING ECHANICAL/PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> _� CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ZTED�WSCIr jWO 123N, f3t_DG,742 PROPERTY TAX#: Z L}11.{OOZ 'O 16,00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: .-itrrE 6 /Zt'7)q- -7 TENANT NAME(If Commercial): CL-E040- £v 1-'' 5k-R,V/G: ' <br /> OWNER MAILING ADDRESS: STREET f c9 I S' 7-7} /,Q,) A-v E 7+- ?CIO <br /> Crry S'Ert STATE 6464 A TIP 9 g`D <br /> OWNER PHONE: 2_06. - S 15'- 06,3-D OWNER EMAIL: lk/E/V 6v e j l(-@S ..i„ co <br /> CONTRACTOR NAME: /12 it, fa,*CI_5, LI,G <br /> CONTRACTOR ADDRESS: STREET S DO 5w /G 71' ST <br /> CITY /ZEA/TPA/ STATE 64/4 z1P 9y05-�Xqvn <br /> S 7 <br /> CONTRACTOR PHONE: YZ.g- 2O 7-V050 CONTRACTOR EMAIL: CRR FY Lt�x42 CKS, GejNj <br /> CONTRACTOR LICENSE#(REQUIRED): /j/j j�2 1 G �T L 9��SIV CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):.01Q141 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> DviewvE see 360- 6z-3 C7Lt <br /> G.A-2E4 c2GiSeA/ Z5-3-• 569.%rj&3NTACTEMAIL: pvoloice, rrt9cK,I.COM GA-tetta/M1rrF►C4S <br /> BUILDING PERMIT APPLICATION cat4t <br /> Existing Use of Building: Contract Price of Work:$ 34,57 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project ❑New ❑Addition ❑Remodel ❑Repair ❑T.t. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> C.4 iv 77(k--vet. $ A-Lt. gol'Ce_jev <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 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 296.2004 WAC. <br /> City of Everett Official Use Only <br /> 41 7c3 /e PERMIT <br /> t t, <br /> Owne Author gent Signature Date (Revised 10112/2015) L/ <br />