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PERMIT APPLICATION <br /> IlIIIPBUILDING I MECHANICAL/PLUMBING I SIGN/SPRINKLER/DEMOLITION <br /> ice' CITY OF EVERETT PERMIT SERVICES <br /> .440 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 ((E)everettepsg?everettwa.gov( www.everettwa.gov/permits <br /> (Blue or Black"Ink Only Please) PROJECT RITE INFORMATION <br /> PROJECT SITE ADDRESS: 463 Oa ker Ave, Evere.m. WA 9502)jPROPERTY TAX#: <br /> LEGAL for new construction: Short Rat/subdivision Lot No. (attach copy of long legal description) <br /> cornAC'I'Illi T ,, <br /> OWNER NAME: V C(.G k Mf)1/Veir TENANT NAME(If Commercial): <br /> T OWNER MAILING ADDRESS: see I qog Q4,,�e,,S' Afire' ( 9Q <br /> CRY r�jt-V LA/Ii"IA ZIP r VUZ <br /> OWNER PHONE: T2s- 2 ri- 3t* I / I�s�[OWNER EMAIL: Uk-&rIT&Iaoh �rcA00 i 66'01 s; <br /> CONTRAC8OR"NAME: .fn2t2 Ali M! r <br /> CONTRACTOR ADDRESS: STREET p 1170 �'3 a s- 4 J 5- <br /> i lie viA STATE ZIP f0 00 6 <br /> CONTRACTOR PHONE: 266-- S" — (1,73 CONTRACTOR EMAIL: 5-41-Irv/Z/1o/`4-1 AZ-Si-e99m4 r 1• -", <br /> CONTRACTOR LICENSE#fREQUIRED): Jjf/141/2- )1,(()CT art OfEVERETT BUSINESS LICENSE WRECK) : L2 r--2I7%-.:14; <br /> PRIMARY CONTACT: 0 OWNER A'CONTRACTOR 0 OTHER(Please Specify) -___ <br /> CONTACT NAME: CONTACT PHONE: f�6_Z, "7 — <br /> /1/ / a-ri. ", <br /> CONTACT EMAIL: �I.cl/'12 I2 /1"' pr.G�J��I- y gnfGL,`!,44,14 <br /> BUILDING PERMIT APPLICATION , <br /> Existing Use of Building: Contract Price of Wo- :$ j `�6 v <br /> Proposed Use of Building: Heat Source: ❑G-.. ❑Electric A Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units. ■Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ,0temodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler al aemolition ❑Change of Use <br /> DESCRIPTION OF WORK: l/� ct (` <br /> frvtiz. <br /> eii-lip <br /> lq- <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 /> 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 /> SPR( t"SUPPRESsioN STS rem" _ <br /> (Chemical or Water I f 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,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 lam 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 <br /> 1 i ( —Q�j " <br /> Ow,-r= .,34'f"1:7"""etfAgent Signature are, (Reoser'9l2, aOrel (, <br />