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PERMIT APPLICATION <br /> BUILDING _CHANICAL I PLUMBING / SIGN , RINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 4013200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION j <br /> PROJECT SITE ADDRESS: t ` '-1 1 H fVE 'E PROPERTY TAX#: a 1 (0`!/ <br /> /5 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT� INFORMATION <br /> OWNER NAME:S Ck f(9AA)l, >{�r�S ��� 1U TENANT NAME (If Commercial): ��� ;(6s <br /> OWNER MAILING ADDRESS: [ STREET t3-1 0004.la(IA '1 vd. jte 205 J <br /> CITY U1ab n C rtL STATE C A ZIP q,--159(:, <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: We s-k2c n. 5 ko-re F1C2 Pco to c+10`(\ <br /> CONTRACTOR ADDRESS: STREET 14,01() NyE qS th S r, Q !�'^7 <br /> CrrY ,,e 1.k 1 Y \l J 11e d. STATE A ZIP q V o 6J O'er <br /> CONTRACTOR PHONE: 142...S, �� y, 0100 CONTRACTOR EMAIL: PmaLJ , c.."-es Ual1S tA1s:cs )• U S <br /> CONTRACTOR LICENSE#(REQUIRED): iLA \F S \'b j- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 20559 <br /> PRIMARY CONTACT: El OWNER CkCONTRACTOR ❑ OTHER (Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Zi(o, 1"1 ( , 142(13 <br /> CONTACT EMAIL: .e O\\„Strvok:k5 , W`i`t0 cent, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building:(,nccopkA-1.9.) t(�GC�Uf ��' Contract Price of Work: $ S{.SCJ <br /> Proposed Use of Building:6coc .t %eS Qp latlL� Qf�c),JC.i Heat Source: ❑Gas ElElectric ❑Other__ <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ElDuplex ❑Multi-Family-#of Units: l (Commercial ❑Industrial <br /> Type of Project: ElNew El Addition ❑Remodel CI Repair .l. ❑Sign ,Sprinkler CI Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: (`z toCo,A e j � „1� . r 1r1� , fl{�I&.i C,'ri�iJiG*, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): C,r1-Y ; <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 List of Fixtures #of List of Fixtures List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow 0reventer(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 Water Heater _ Other: <br /> Exhaust Fan Sink (Service/Bar/Mop/etc.) Other: <br /> SPRINKLER / SUPPRESSION SYSTEM <br /> Number of Heads Lk <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 /> PER IT <br /> ��--� +a- as - ►tO C2 - CDO5 <br /> Owner/Authori Agent Signature Date (Revised 9/23/2016) <br />