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r • PERMIT APPLICATIO. <br /> 4677 BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I 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: L 2- ( S� Eve,y-e rT 1..46,,CL i,✓cz y H PROPERTY TAX#: 004 go'ZQ a Z 0(Z <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 5,-Hi/L4 I NC- TENANT NAME(If Commercial):4 r- j <br /> OWNER MAILING ADDRESS: STREET Z2 1 S-e ekr-e i-e-17 MALL L../ y /� , <br /> CITY L V4.iCPVh ,J STATE \r� ,.::.-1._ ZIP CIO Z(V'e <br /> OWNER PHONE: L,ZIi -y0Oy- 3gZi 4I OWNER EMAIL: <br /> 1 <br /> CONTRACTOR NAME: (y-frs i-fetlirt <br /> CONTRACTOR ADDRESS: STREET 31/QC( \f f�,t/r''f.! Ave. , <br /> CITY tJ //le.,!' STATE W cam_ ZIP Citt 2-Q ' <br /> CONTRACTOR PHONE: II ZS 6iQ-L12.' ? CONTRACTOR EMAIL: v)_nvb ' .6k55i_k.>ccY1,,,,,.cO."! <br /> CONTRACTOR LICENSE#(REQUIRED): /y_j HeetC ({.39-13 k CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): i I eat <br /> PRIMARY CONTACT: ❑ OWNER A CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> JoviL'2 t t h ru tr I( CONTACT EMAIL: j; ,,l:.e ,,ng.s.i-i'G„r l v17....:_t7'vin <br /> BUILDING PERMIT APPLICATION <br /> Existirlg Use of Building: 4 --Irk '57c.9 re Contract Price of Work: $ 0,- �;)C ...r <br /> Proposed Use of Building: Heat Source: OGas AElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex DMulti-Family-#of Units: Wommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel VRepair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ) ��C.;�-(t't jTC-2 v,/I7� ,Lk..✓ L.,kA (C.-- e (014 (.1.A.-.11.. IL) <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 , I :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 _ - <br /> 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: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 a horized 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 Stat ontractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> %'' PERMIT# ©�� <br /> '/ ,- 2/Z ) 7 m ��o?J _ <br /> Own utherized Agent gna ure late (Revised 9/23/2016) <br />