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I <br /> ____ ... <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING I SIGN/SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> viiiitor 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink 3 n11/Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 30zO p,,/1,I PROPERTY TAX#: Oo(.f7c7oD1-z <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 5IIC Ivw,atl t4L'TH (9lCl 2i t TENANT NAME(If Commercial): �f OMl5G 1`f!tv4�77f <br /> OWNER MAILING ADDRESS: STREET 302.0 f2t/L{GNL- <br /> city L1)t51t6TH ?A STATE (4J-4 ziP rt tr22oyl <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: C vC.2 !E?AJ ?t1OrT6" C7('iEE-r 04,6TA-c. <br /> CONTRACTOR ADDRESS: STREET 21210 PAGI viz. iscU t <br /> CIN r:.+VGYC.1T STATE (AJ ZIP ie720/ <br /> CONTRACTOR PHONE: 425,25 2-3t/q - CONTRACTOR EMAIL: mAgAILQ£$91uwA .(-e <br /> CONTRACTOR LICENSE#(REQUIRED): EUGY2 .5S pztv'l' CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CS 6-7 GP.✓�- <br /> PRIMARY CONTACT: 0 OWNER &CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAM : CONTACT PHONE: 425_2- 2_x//9 <br /> kWh riffix CONTACT EMAIL: A(/4ai i_ 0 c i eb^ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: No �i4IL)6c- I Contract Price of Work:$ /7,d00 <br /> Proposed Use of Building: No Heat Source: ❑Gas ®Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ClAddition ❑Remodel Repair OT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 2,,,,,er1,00, 024- `xtf 3- t-#rAT IQ"J'°' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> .MECFIANICAL.PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn Alteration r Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC–Air Handling Units f 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 /> • <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/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 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.lam the owner,ori am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 98.27 RCW and 296.200A WAC. <br /> 1 City of E�vereetttOfficial Use Only <br /> q- aki <br /> 7 PERMl�,#/� 1` 9 — 0r ry <br /> Owner/Authorize gent Signature Date (Revised(5/`2/0/2016) `\J (x, <br /> i � <br />