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4 <br /> 4rETT PERMIT APPLICATIOfr.. <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN ) SRINKLER/ 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)) p PROJECT SITE INFORMATION a;111/ <br /> � <br /> PROJECT SITE ADDRESS: #/# J-IZV RUCKP(/4�.-,�11.Q�( k)D 2Q) PROPERTY TAX#: U/1{1130050 i3O0 <br /> LEGAL for new construction: Short Plat/subdivision ____ Lot No. (attach copy of long legal description)(41-4-licked) <br /> CONTACT INFORMATION <br /> OWNER NAME: j/Lfl je PQ44- (5 let- LLL TENANT NAME(If Commercial): Tit-c. EihQ te-1 --GL2t1:c <br /> OWNER MAILING ADDRESS: STREETJ�fc,/� (�11 ,4Kt , � <br /> CITY EV`ty`tT°r, STATE /AA ZIP (/�0n <br /> 2-' <br /> OWNER PHONE: OWNER EMAIL: / <br /> CONTRACTOR NAME: (AtliUer ;-�Y /Ke.c(u+vilcq I (6s1-ra Cf-D(5 l f ic. <br /> CONTRACTOR ADDRESS: STREET x/]1.6/1 , 'Q.4 f/ III) r G ]_� <br /> / CITY /Vluk (J' STATE b✓u� ZIP q /z'( ,J <br /> CONTRACTOR PHONE: (206) 6) - 06(6 CONTRACTOR EMAIL: ,/i:''t.• kb tUi 9 e l71't4C t , 0,,4.------ <br /> CONTRACTOR LICENSE#(REQUIRED): UNI RAC*3L1 /iq CITY OF EVERETT BUSINESS LICENSE#(REQUIREk(0,6?Z•C�/ <br /> ,� <br /> PRIMARY CONTACT: El OWNER CONTRACTOR ❑OTHER(Please Specify) _ <br /> CONTACT NAME: I ID G CONTACT PHONE: (, ) — 05/5 <br /> 1.1eh ry C Z3 S CONTACT EMAIL: k Q5 Q Vn"-c. .co <br /> BUILDING PERMIT APPLICATION,--- N. <br /> Existing Use of Building: "Aed(Gu( �jeirvtCt- Contract Price of WoY $ CS.ACT 2 0 <br /> Proposed Use of Building: /lAtdlai( 3e.rv;ce-5 Heat Source: ❑Gas Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial 0 Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair DTI. ESign ❑Sprinkler ❑Demolition EChange of Use <br /> DESCRIPTION OF WORK: <br /> f-e-014 44 (lea ce._ (ey a-) Io-P-4- e 04;k-. Lim -.„ (.cam 6. ' --k. <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 /> 4#of #of #of #of <br /> •Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> ci <br /> I 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 /> L �•' Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove _ Kitchen Sink&Disposal Grease Trap <br /> _ <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 /> Chemical or Water I No. 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 with the State Contractors Law 18,27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> A111110Siii. 9/577,6/7- PEM � `- - D29- <br /> Owne,Authorized •• Sign.ture D (Revised 9/23/2016) <br /> i 1.2.... <br />