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grrJJ��11 i • <br /> S-0103PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1oseas. cn "Rom(b PROPERTY TAX#: v2J COI(eW <br /> LEGAL for new construction Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> •OWNER NAME:11)1,x* krfIL�Jm.('CSL(CS LISA- TENANT NAME(If Commercial):tyrft c ec „cLs— <br /> OWNER MAILING ADDRESS: STREET( ç7 aQhfd SA-C n st <br /> CITY 1.0S 1' el,FS STATE 34 ZIP q 7 <br /> OWNER PHONE: 201,0 z Z) LIS- 0 OWNER EMAIL: C'bnn1cj► Q L LA,Lifiett4r-SZ45004 <br /> CONTRACTOR NAME: 14014 A dr S <br /> CONTRACTOR ADDRESS: sTREETt. 00 .5 t 3y PrP <br /> CITY 'p atat. STATE L>LZRCONTRACTOR PHONE:2/No1Sa (4 30 CONTRACTOR EMAIL: I(ljh A14.11 J't() a ' I.,) <br /> CONTRACTOR LICENSE#(REQUIRED): <br /> �WbLa,1pT37el -Q CITY OF EVERETT BUSINESS LICENSE#(REQ D): IZ6s3 <br /> PRIMARY CONTACT: 0 OWNER 6d•CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: �` CONTACT PHONE: .7,,,, <br /> K a <br /> drdIft CONTACTEMAIL:0Dmir <br /> 0.,...„ 1Y1,0 7 .co IN <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: LoKi l L26 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric CI• her <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: I ❑Co•"mercial ❑Industrial <br /> Doe of Project: ❑New ❑Addition El Remodel ❑Repair ❑T.I. ❑❑Sign ❑/Sprinkler NI Iemoli.�•- ❑Change of Use <br /> DESCRIPTION OF WORK: a� ��5� ca zZ614� Tcf. WR.,z,. ad el- nni V t FtA c1 Vet-CA/CS/ <br /> 5, M- 0•.0.2‘5606 ie s . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn Alteration Repair ype of Project: _New _Adds _Alteration _Reps' <br /> #of List of Fixtures #of List of Fixtures #of st of Fixtures #of List• txtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflo, '•reventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Uri.: <br /> Gas Piping Boiler Lavatory(Wash B. . •rinking 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 •-dical Gas <br /> Range Hood 9. Water Hea - Oth • <br /> - <br /> Exhaust Fan Sink - ice/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number 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.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 he State'Contractors Law 18.27 RCW and 296.200A WA* <br /> City of Everett Official Use Only <br /> ► ( PERMIT# <br /> 1111111 --4e" M, ('1 OS — 0t <br /> Ow : •u : • Agent ignature I ate (Revised 9/23/2016) <br />