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PERMIT APPLICATIOI1- <br /> ,,��11��,,,��� BUILDING /MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> IP CITY OF EVERETT PERMIT SERVICES <br /> ,sw3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov( www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: _5t9 )p7ae /2/a Ci= PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 0/Yip pL. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET -p, b L 0 Y i✓2fi y <br /> CITY J / STATE to A- ZIP Q,PGC/!l/ <br /> OWNER PHONE: //,2 -25.2 J OWNER EMAIL: 04.vin fl PA-le k.. LL-e) <br /> CONTRACTOR NAME: I<A7',/- - (Ocokkec) <br /> CONTRACTOR ADDRESS: STREET p, ( ('60 2.627 <br /> CITY 6-Teleiti— STATE CSA. ZIP 4'g,Zp,( <br /> CONTRACTOR PHONE: 94.12-1' 6 ko -t1, . O/2, 40 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED) iU/A- "124d 66"441.) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) <br /> PRIMARY CONTACT: iSit OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACTZ <br /> NAME: CONTACT PHONE: h�ZS'� 5 Z 3t O <br /> A-tzr 6 k-oTIotcL-- CONTACT EMAIL: A-pj-e' yr kp712 AL, o Co✓yl <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 0 Contract Price of Work:$ (3,(000.00 <br /> Proposed Use of Building: pc-s 2. Q- A-Ec_ Heat Source: Idas ❑Electric ❑Other <br /> Building Type: tiit FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: [ lew DAddition ❑Remodel El Repair DTA. ❑Sign El Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ��— t4 Z j� v � �� t <br /> e- P Q-a E4-rzo� cf CI eA A <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 List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> 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 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.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 /> PERMIT# <br /> %'%'/ I 60V* Oti3 <br /> Owner/Authorized Agent Signature Date (Revised 5/20/2016) <br />