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41477 • PERMIT APPLICATION• <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (F')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 /> a <br /> PROJECT SITE ADDRESS: 9'95 v is 'iu (r 1 , o pZ 3 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> /J CONTACT INFORMATION <br /> OWNER NAME: ck <br /> � � riv) 1aCV' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 49s �1 V A;Q` P I �J �/ 7� <br /> CITY 6j mut STATE W 11-- ;^,ZIP f/ ,0�,�,,,C/S <br /> OWNER PHONE: 42 , 33 7 - 90/7 OWNER EMAIL: Ef(p 2 8$Z I (D. e o 0 • t-Y►V <br /> CONTRACTOR NAME: M 0k-7v-b.) y)5)-yu ch ovk / 0-(7Yt40k.vin nil U.l r <br /> CONTRACTOR ADDRESS: STREET I-30411 1 l,P ave.5-0 �j u /�(� <br /> CITY p��l�;/• K/• 1 S 1 DLJt. STATE WA ZIP 1;.7O�T c I_ <br /> CONTRACTOR PHONE:1-V\�v_gy-,T eiq Ej , . CONTRACTOR EMAIL: Jo rittho . VYI air1!'rnat 0e9 u'h t'I'i)l1 <br /> �3 118�� re c,��► <br /> CONTRACTOR LICENSE#(REQUIRED): ZD(p CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR 0 OTHER(Please Specify) A 0/4.--(11(t <br /> CONTACT NAME: { �/�� CONTACT PHONE: C�6 - j„ 3- �31 / <br /> for e I hj_it p f l i r CONTACT EMAIL:;0 yic tkA.► .. WI t 1.1 r !�% i'Y aiTeL)fiZ;OreictiliiIn re1Q t V <br /> / <br /> &Wet <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: T`,S i d-VVl I l CO 4•30\41f. -.,y).U1 Contract Price of Work:$' k , , Z6 0 <br /> Proposed Use of Building: 5-UV J J Heat Source: ❑Gas pectic ❑Other <br /> Building Type: ❑SFR-Detached [9FR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel 'E)epair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: (S, OL SAD9) it ik Io( *i prl w I V mkt, ust of- <br /> ?atl <br /> f- <br /> 2jth' ri-ers <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 #of V #of #of <br /> List of Fixtures List of ktures List of Fixtures List of tures <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/Mbp/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 wit e State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> i I/2,011 13 (to ( ( — o 35 <br /> Owne Aut rized Agent Signature Dat (Revised 5/20/2016) ,, <br />