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• • <br /> PERMIT APPLICATION <br /> 054.17 BUILDiNG/MECHANICAL/PLU?J :ING/SIGN/SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permifs . <br /> . <br /> (Mede or Black Ink Oraly.Please) : PRO JECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: SLf /14/4/256-4 PROPERTY TAX#: hyo /fez <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> .. . ..CONTACT.INFORMA`IION . • • . <br /> OWNER NAME: 6chv/tt S( ' f.i TENANT NAME(If Commercial): 6Cy,(.1 SoT 56,4-5 <br /> OWNER MAILING ADDRESS: STREET �8l/ /ip(Setc) yT -/o <br /> L�, CITY F%4/ 4.44/6 <br /> STATE WA ZIP98 ZOOWNER PHONE: /4(. 16 /44.' ....._._........... .... .. _ OWNER EMAIL:.,. @ ilk .:. ,._.. M,_ ........... <br /> CONTRACTOR NAME: C U Z.6A S'nor-RC (..1E-1-7-1/14,67A-c... <br /> CONTRACTOR ADDRESS: STREET 24 PA�i Au e- <br /> CITY !✓V 0 STATE�(�i �/ ZIP� E S20/ <br /> 5. <br /> CONTRACTOR PHONE: q- °�S 2-"5/t44 • I CONTRACTOR EMAIL: 4y201 '-,�/�' cG;Qtui c.l:G►"I Ow— <br /> CONTRACTOR LICENSE#(REQUIRED): COG-1246S®2Gc�-1- (CITY OF EVERETT BUSINESS LiCENSE#(REQUIRED C)6-7155- d <br /> PRIMARY CONTACT: 0 OWNER IaCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: PHONE: 4 2 5,---25-2 d3//c <br /> /4,4� 4._ CONTACT EMAIL: welt L T <br /> BUILDING PERMIT APPLICA N <br /> Existing Use of Building: !/O C4tC'c I Contract Price . Work:$ 20 <br /> Proposed Use of Building: 1\1 0 el (i d Heat Source: SIGas •E6-(14., Dot -r <br /> Building Type: ❑SFR-Detached CISFR-Attached ❑Duplex ❑Multi-Family-#of Units: ($Commercial ❑industrial <br /> Type of Project: ❑New 1]Additlon ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler DDemolition CiChange of Use <br /> DESCRIPTION OF WORK: <br /> g e. 5n tu6 ;IDti) 5pi-t r y j Stew toe(7 S-12--c--12- 6 /d a 'c) 5/-›- t- <br /> DA Uti rt 1/6)titD alif w Claa <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECW.ANICAL.PLRMIT APPLICATION ' • PLUMBING PERMIT APPLICATION • <br /> Type of Project: _New Addn _Alteration Repair Type of Project: New Addn Alteration _Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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 • <br /> Refrigeration Shower Floor Drain <br /> Gas Fireplace 7 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 /> I PRiNXLF %SUIP PRIESSION 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 lam authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ill <br /> / j City ofEvverrettOfficial Use Only <br /> IPERMITyk <br /> ICCtG 1 i t7 1oct - 0� 1 "--1(.?/-)&vri>'1/Authoriz gent Signature Date (Revised 5/20/2016) <br />