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PERMIT APPLICATION <br /> ,..�.� BUILDING / MECHANICAL I PLUMBING/ SIGN / SPRINKLER/ DEMOLITION <br /> Nisi CITY OF EVERETT PERMIT SERVICES <br /> 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 /> I(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: (DJC 5 aciti PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No._ (attach copy of long legal description) <br /> . �,j i CONTACT INFORMATION <br /> „ <br /> OWNER NAME: Li Y � \kw.j-�-(f „`i-€.., TENANT NAME(It Commercial): <br /> OWNER MAILING ADDRESS: STREETT-6-�j(�j(`,���p�7�"—��- Ed 1 y� p <br /> CITY �....M)eit "L/4��-+��� STATE L J a �pbi 3 <br /> ZIP <br /> OWNER PHONE: 1425 L43 Pig-7 OWNER EMAIL: <br /> CONTRACTOR NAME: 4t n ,n c <br /> CONTRACTOR ADDRESS: STREET tL4t faroactwoi <br /> CIN ex)./2.21„tZt STATE ^- ZIP ctg <br /> CONTRACTOR PHONE: LZS 2.,C3Ct 0550 CONTRACTOR EMAIL: LI @,, CXVULdtfljf • <br /> CONTRACTOR LICENSE#(REQUIRED):C,11/4i tDSR i4_ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) <br /> PRIMARY CONTACT: ❑OWNER (YCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAM ICONTACT PHONE: 4.26 2,592,59O�0590Dolati LL ��� <br /> CONTACT EMAIL: a e (2,11`btitec .v .Corvj <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ •4>Sf:) <br /> Proposed Use of Building: Heat Source: Gas ❑Electric DOther <br /> Building Type: *FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Fa g -#of Units: OCommercial ❑Industrial <br /> Type of Project: :New ❑Addition ❑Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Re , <br /> Laza 5cs -urV C C-.Q_ <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 #of <br /> Fixtures -_List of Fixtures List of Fixtures - #of ListofFixtures #of List of Fixtures <br /> Fixtures �•• Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg) <br /> J 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/BarIMop/etc.)_,Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water 1 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,stale,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 t comply with the State Contractors Law 18.27 RCW and 296.200,4 WAC. <br /> City of Everett Official Use Only <br /> PE1y�T <br /> 0u 12. 20.1"7 Yv � ` Z -0q 3 <br /> Ow er/Authorized Age Signature Date (Revised 9/2016) <br />