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PERMIT APPLICATION <br /> ✓ BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER I 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 everettwW gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 702.) k." hire, SE Ev_r_ttE q120-3 PROPERTY TAX#: U O'23Oo3 SO I <br /> LEGAL for new construction: Short Plat/subdivision ;.tit No (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: like ;tjy c TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 70Z..1 pl�.:ay.51,1(z617I/ Se <br /> tva -rr WA- q W3 <br /> OWNER PHONE: 425.. y2z- 'L, OWNER EMAIL: 04 le t4 t}6) 4,‘,"1<_0.etryvi <br /> CONTRACTOR NAME coe/VCR-csroNE I2cOF/N&` /'VC• <br /> CONTRACTOR ADDRESS: ,,Nt_s-r 010.2Y /is-H-i .n S£, #.10) <br /> 77ELL :.,f. f <br /> CONTRACTOR PHONE: '`1 5--l,:po——42/1/ CONTRACTOR EMAIL:krisiLj ('c7�1 N ,/f i Dic-f/Vtr,,,.,C0.02 <br /> CONTRACTOR LICENSE#IREQUIREDi: C R JElf'. 1,_/jCir) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0336-6 <br /> DRIMARY CONTACT: 0 OWNER g<ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 1.26--lei---0//i <br /> SARA coQNIS N, OFF/CE rn4NAC7E,Z CONTACT EMAIL: I.i,, r 7 r &. , <br /> BUILDING PERMIT APPLICATION ,.-"'� >> <br /> :xistinUse of Building � <br /> 1 �l R Contract Price of Wvtk: $ <br /> 'rs.oposer Use of Building; Heat Source: ❑Gas -❑Electric ❑Other <br /> kidding Type' liSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units:µ, ❑Commercial ❑Industrial <br /> 'ype of Project' ❑New ❑Addition ❑Remodel fErRkfrag OT I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> IESCRIPTION OF WORK: riG-g <br /> >eemm rye. P 4, A-e-filati 142-- dime <br /> 1SSOCIATED BUILDING PERMIT#(if applicable) <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> ype of Project: _New _ Addn Alteration _Repair Type of Project: _New _Addn Alteration Repair <br /> fi of #of <br /> °fixtures List of Fixtures List of Fixtures #01 List of Fixtures #of List of Fixtures <br /> Fixtures <br /> 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 BoilerLavatory(Wash Basin) Drinking Fountain <br /> 'Water Heater Refrigeration Shower Floor Drain <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 I SUPPRESSION SYSTEM <br /> Number of Heads <br /> + <br /> CKNOWLEDGEMENT.I have reviewed this application and confirm the information contained herein is true and correct Work done pursuant to Mrs permit must comply with <br /> irrent federal,state,and local law rhe granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> aiding 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 /> Id/comply with the State Contractors Law 18 27 RCW and 296 200A WAC <br /> City of Everett Official Use Only <br /> 4--- �l f 9043 ,r PE # <br /> Diwz-_,1e. o n (2 03(^,-, <br /> wneriAuthorized Agent Signature Date (Revised 5:20/2016 <br />