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ki-liSerr • PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN / RINKLER/ 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 I FORMATION <br /> PROJECT SITE ADDRESS: 2 9 2 .).._)c SLt 1?e PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: cwt e.re.1 LLL TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> ,/�� q() 11,0 . 14660 /� <br /> CITY (AM C(ez�L STATE (JP- ZIP 9b082 <br /> OWNER PHONE: OWNER EMAIL: T <br /> CONTRACTOR NAME:._-1 J ?;,,pA , q <br /> CONTRACTOR ADDRESS: STREET qU0 .i GIc4,1 t2„04, <br /> CINCI(C1r\,}-'1- 'N V.. STATE uuk ZIP c\B)r)Z <br /> CONTRACTOR PHONE: 3(00 322 --4_2.91.61 \\\ CONTRACTOR EMAIL:Liovv j v rulbt,n j @kn},m,,•t , .: <br /> CONTRACTOR LICENSE#(REQUIRED): <br /> &OC) 5-y 7 (j 3CITY OF EVERETT BUSINESS LICENSE#(REQUIR=D.A0100,0,/ <br /> PRIMARY CONTACT:G' OWNER X.CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: • Co L "}-22 CU`\ 1 <br /> -3 n 00\D,-e-(- CONTACT EMAIL:' '`ctAd,i () 1 VA/lb i A9 e►'1C7k11ACi1 k , CGVVA <br /> BUILDING PERMIT APPLICATION \ <br /> Existing Use of Building: Contract Price of Work.$ ��CC-] <br /> Proposed Use of Building: Heat Source: ❑Gas Ill Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: eSICommercial ❑Industrial <br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair BiT.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Sc.ii- , 4cnn `� 1 <br /> 0, 1A \\ 17\"4v00°%.rj 1,1. -k <br /> as�i+ or v\e-t.•) crcce` Shue <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 #°f List of Fixtures #°{ List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-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 7,).... Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal t Grease Trap <br /> Gas Range Ducting 1 Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater o - . ' ` IL <br /> Exhaust Fan Sink,(Service/Bar/Mop/etc.) - -- : . s,' Ik. <br /> (4—i-5t ` ) n <br /> SPRINKLER/SUPPRESSION SYSTEM -1--- rtrcig-§r i 1 C-,tr-e C,S e fro, f9 <br /> Chemical or Water I No. of Heads \ CIO vb\c'- cinecV_ 11AIJ, A, 1-a PI' t. •r+-( <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the informa 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 approve work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official b-fore 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 t 6'State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 1:7A-►I-- PErt Z (`)($ <br /> 0. . r'-d Agent Signature Date (Revised 9/23/2016) <br />