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4L-7. PERMIT APPLICATION <br /> BUILL /MECHANICAL/ PLUMBING I SIGN tINKLER ! DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICE <br /> 3200 CEDAR STREET,EVERETT WA 98201 <br /> iP)425-257-8810 I FAX 425-257-8857 I(E)everettepsGeverettwa gov I www everertwa acv;»m ilt4 <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: <br /> 3`:i 3 P,IJ.r ,-rc[:._ A JEE.,.ier,e-ct Wil cA4'La l <br /> LEGAL - ,+ instruction Start Ptausuoij vision Lot No (attach copy of long legal descriptions <br /> CONTACT INFORMATION <br /> OWNER NAME: Pica JP1'.,] NA-T1-O� TENANT NAME(If Commercial): t.Jf r)ECR.tMF <br /> OWNER MAILING ADDRESS: smeei ?© 'BOX I eS?,p(it <br /> CRY E'ERi\ k/ WA ,TA., W A ;20(o <br /> OWNER PHONE: Li ZS 32..T -7 r C OWNER EMAIL: AV-LA t.I.Ek� a-ck. r) (SMC. <br /> A\L. O A <br /> CONTRACTOR NAME S P V2- eoi I p7(/ t,v--r(,oil l L.LC <br /> CONTRACTOR ADDRESS: ,)BEET 7/7 /9 T# 5/r, N <br /> r W Ji4-IZ44a. ci Lv/4, STA I 9S-9S-S02- .''Pr/ <br /> CONTRACTOR PHONE: $6C1 2.(-4—(930—2.(-42S CONTRACTOR EMAIL: R L$Y�/�4✓LYLS 5 n <br /> g C�/w/0V,(-00-1- <br /> CONTRACTOR <br /> -0 -CONTRACTOR LICENSE tl•1 _! '=r, S PFax Lgct()0 0 CITY OF EVERETT BUSINESS LICENSE WREQUIIREDI 9--,-. 4-10 > <br /> PRIMARY CONTACT: C OWNER CONTRACTOR Ci OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: .--0q--(030— 2(-12 9 <br /> Rod i-i sip/4 s CONTACT EMAIL: 1__Sto4-1 k 5 ss Q-y , i erpt t <br /> B ILDING PERMIT APPUCATION <br /> Existin• Use of Buikit 6 17126 a u�ad Contract Price of Work:$ 3 Sou° <br /> Proposed Use of Butkdin• I - iz.4 '0 Heat Source OGas Electric Clkher <br /> Building Type ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-a of Units igCommercial ❑Industria <br /> Type of Pro)ect DNew ❑Addition ARerrodel ❑Repair DT I OSign ❑Sprinkler ❑Demmo�litiion ❑Change of Use <br /> DESCRIPTION OF WORK: i��l/(2r�T (•t et,5t J (5P#-�z /N/NT() V4-e �t ✓ <br /> "" C 4 -. <br /> ASSOCIATED BUILDING PERMIT#(it applicable) <br /> MECHANICAL PERMIT APPUCATION PLUMBING PERMIT APPUCATION <br /> Type of Project: New _ Addn _Alteration _Repair Type of Project: New _Addn Alteration _Repair <br /> aof aot aot aof <br /> List of Fixtures List of Fixtures List of Fixtures Fixtures List of Futures <br /> Fa tures Fixtures Fixtures <br /> A/C-Air Handling Units Heal Purrp ToiletBackflow Preventer(Inside Bldg) <br /> — <br /> Forced Air SystemsUnit 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 8 Disposal _Grease Trap <br /> Gas Range Ducting Dishwasher _ Roof Drains <br /> Clothes Dryer Hool•tri:s Other Clothes Washer Medical Gas <br /> Range Hood Water Heater Other <br /> Exhaust Fan Sink(Service!Bar!Mop.`etc t 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 witr <br /> current federal state and local law The granting of a permit only authorizes approved work and no deviations therefrom Deviations must hist be authorized in wring 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 wn+ch appicadon a Maur <br /> .rho,carroty wan the State Contractors Law fa 27 RCW and 296 200A WAC <br /> City of Everett Official Use Ony <br /> PERMIT# f (O l o <br /> Owner/Authorize go—Signature Date !Revised 10/12/2015) <br />