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I <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 11141/4; 3200 CEDAR STREET.EVERETT.WA 98201 <br /> (P)425-257-8810 i FAX 425-257-8857 I(E)everetteps@everettwa.gov wvwv.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: zq/ c—� - PROPERTY TAX#: etit,e e70.6-9i5--r 7 ?o„2 7 O� <br /> LEGAL for new construction Short Plat/subdivi�/ <br /> sion_ _ __Lot No (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: C,L1/( K /e h/L/N'' TENANT NAME(If Commercial): di0/./41 5ifi JOr FA,QM S <br /> OWNER MAILING ADDRESS: STREET 247/ �.517-147-e- ST <br /> � T $ i i Te- /o 962019 <br /> ��yC�} 01 <br /> CITY �(IG-.�Ci�7/ STATE 7 <br /> ZIP 6 01 <br /> OWNER PHONE: 2 7° <br /> 06 ' '2 S � OWNER EMAIL: mkt ,e tn0/JSig NC'T/D/`/ • co/1•4 <br /> CONTRACTOR NAME. <br /> CONTRACTOR ADDRESS: STREET <br /> are LIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR gOTHER(Please Specify) ANo/eEL1J reISTof"/C <br /> CONTACT NAME: !��/ CONTACT PHONE: 1146--‘i q-7-03 09 <br /> /V 1 e t1 ej7 ✓/Gb CONTACT EMAIL: 4AIptt 'u1 qe../iv/TyT/Y/Ej/e 1". c A-1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 0//f)e-e-/-104e e Contract Price of Work:$ I )-Z 0 C(1 <br /> Proposed Use of Building: Q,l 'i',1A/5 14.,?ucT/Gr✓ Heat Source. ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units ,Commercial ❑Industrial <br /> Type of Project. ❑New Arliothditten DRemodel ❑Repair l ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �,NSTsfl�f //L Ce9A4PESSu2, �mTeIZ L!��tT L / /L �f/J/v GG//lI�' <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 _Adds 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 /> 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 /> 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 / Cc.' P2ESSUCL I Water Heater Other. <br /> Exhaust Fan / C.L. e$0,t trice./ 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 befor b•ing authorized under any circumstance./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 comp with .•S:te Contractors Law 18 27 RCW and 296 200A WAC <br /> City of Everett Official Use Only <br /> g4,0 PERMIT# <br /> 61 /SA)4/16e Re-a- 3-/1 -/ 111140-3 .67,0 <br /> Owner/Au on ed Agent Signature Date (Revised 10/12/2015) <br /> Ee() <br />