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PERMIT APPLICATIONAK <br /> BUILDIN(MECHANICAL/PLUMBING /SIGN iPPRINKLER/DEMOLITION <br /> 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 /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: nal COM( AVE A . <br /> 91111 PROPERTY TAX#: 004014 22901206 <br /> LEGAL for new construction: Short Plat/subdivision Lot No.17.-(s (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: C1gg,Aki IEN)14_, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET t'2o1 CAUS.1. AJC. <br /> crw Ertl STATE wA ZIP 'it?D+ <br /> OWNER PHONE: /lb•931.Ov`1D OWNER EMAIL: GPOLIIV'xAVKItt 4) CrVIAtL.•CAwt <br /> CONTRACTOR NAME: VAN 0\101.11a.X. ( j ritA.crWN Its. <br /> CONTRACTOR ADDRESS: STREET 'PO eibk G a i <br /> CITY %140‘SUAAVI STATE V t A ZIP 982°t <br /> CONTRACTOR PHONE: LIZ.S• ' O • 8280 CONTRACTOR EMAIL: TILAvt3.VANtiVB'E Q Gvut4►t ..•COMM <br /> CONTRACTOR LICENSE#(REQUIRED): ypNQ\J C i5"1 J CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0 (1 &7,1 <br /> PRIMARY CONTACT: jl OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: tag •`13 . <br /> GAUL) c5 tt CONTACT EMAIL: &AtuV.sc44 ,At..€ GtkmaL.c00% <br /> 44'44 � n <br /> • <br /> ebiLDINGPERNilet APPLICATION <br /> Existing Use of Building: St LiE tpyyL Q Contract Price of Work:$ C140U•TA <br /> Proposed Use of Building: 511.1c, '"f lWM . (tom, Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached is SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial [Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ODemolition OChange of Use <br /> DESCRIPTION OF WORK: pcpuic,t. E,sCist1 1 c)9..AT-%LI loft-IVE Wj -j tiu/ pQ.1 tnlit'j Cc?-AM. <br /> Reitt t• It BEL eAt4v0E. Gva 44 p6U'wkrfif►rary <br /> vuMA. (Gat%►c.)- <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 #°f List of Fixtures List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures 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 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 <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.lam 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 /> PERMIT# <br /> ( 4AA. CS?/..•••.A&— <br /> �I.25.1 to �J ( lo0`F' 09( <br /> Owner/o hed Agent Signature Date (Revised 10/12/2015) J 2 <br />