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• • <br /> 471E7TPERMIT APPLICATION <br /> BUILDING / MECHANICAL I 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ,� ( I•-'r7-8i-*&T=k- I 't`)"�C-- PROPERTY TAX#: ( 1 17-�' z-LI 3 1- ",(1c-C( <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1 :--71-,--ti-v( i:_ P i20V-6-LSlc r+n`t--C.)-4-'/Zi:.,TENANT NAME(If Commercial):-I i'+r. ` •:r L-US L.✓4-t-v t=' ..'... <br /> OWNER MAILING ADDRESS: STREET _- 3, t' o-E 1-?r,i',-L. <br /> city U✓L'F'6:-T- `/ <br /> STATE vb 1yI zip c) Lt.• /'` ( / <br /> OWNER PHONE: t., 2 5... SC t: t-,C`C OWNER EMAIL: <:.-:..vt:16Li<' Idc... '-)Lr i t: le(s ('- c9 4., I C Cl':.-i <br /> CONTRACTOR NAME: R L ---Y CVNSTv-tc rz--a.. <br /> CONTRACTOR ADDRESS: STREET 7' c.,• LI; .-2 ‘- <br /> CITY LH VZ Q./ STATE 1/N)A- LIP 9e2.06 <br /> CONTRACTOR PHONE: L'2 r; 3;�rii 2 LI L- CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): L l k C.C1 ei C'T 13 O CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0 1* ( 7 <br /> PRIMARY CONTACT: 7I..OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: (e„ CONTACT PHONE: LI 7 --- 36 c; LI 6:6 C' <br /> rk-V-i_tr.,, ->t-4-:.1:12'L---6°; CONTACT EMAIL: •''L,5.-,,.-t vt<1(.i a r \. L .'Ai r(r( � 'j.a,,A.-(- t.:i+w.•1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 1-Ht=r'L'I2-- SO4---1.-Cw' Contract Price of Work: $ -I i (- "C <br /> Proposed Use of Building: Oc"+c(.L 'S i't`}C(.., Heat Source: *as ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ESFR-Attached ❑Duplex ❑Multi-Family-#of Units: commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition DRemodel ❑Repair WI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> i.6 rt, i%2.. 1 sr)7-11z.a=U2 ..-ivZ c f--F e- <br /> f,0.k,.) i.> o�S 4 (".,ub�b�.)s c"IU I'Rca <br /> - 4T" .. C o-korbe- F-141-4-66--- <br /> ASSOCIATED <br /> -141-4-6 -ASSOCIATED BUILDING PERMIT#(if applicable). <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn _Alteration Repair Type of Project: _New y!Addn '-' „Alteration Repair <br /> #of #of #of List of Fixtures #of List of Fixtures <br /> Fixtures List of Fixtures Fixtures List of 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 A Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting r Dishwasher Roof Drains t <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 dome 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 Contraetors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> Ii _ 2 t:'. . 1 PERMIT# 1^ 0/ 00b <br /> OwnerlAuthorized Agent Signature Date (Revised 9/23/2016) <br /> i <br />