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PERMIT APPLICATIMI I <br /> BUILDING/ MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ 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 /> (Blue or BlackTInk Only Please) PROJECT'S'ITE INVORMATIION, ; <br /> PROJECT SITE ADDRESS: '43Z2. — 2 5411 O ve Sou-i-L efi54-- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> Q` „CONTACT INFORMATION <br /> OWNER NAME: jarkta5 -f-,(tp62t�Lt, 141.4504-1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 43ZZ 'ZCP41 •` /� <br /> CITY �-1/&P---e-t+[ STATE (Ai/1 ZIP y8 203 <br /> OWNER PHONE: 425' +bOL/— 3269 OWNER EMAIL: �)b (5 i p� i44l/• t ! <br /> CONTRACTOR NAME: gel /C.&cJ f.44-e-r00Ag- .S f-Ar irKS <br /> CONTRACTOR ADDRESS: STREET f 0 7-33 — PL cv.e S f- <br /> cITY M cJ KI I-le o STATE (AJ f- ZIP 5z q3— <br /> CONTRACTOR PHONE: 42-5-- zl-g3-5353 CONTRACTOR EMAIL: YO (andst c-6 !e/reel <br /> CONTRACTOR LICENSE#(REQUIRED): j,??f R.ee5 SS€O CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 1/602g <br /> Z8g <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:` CONTACT PHONE: 4200—4L 3 -5353 <br /> )/o/an da £f�'6 CONTACT EMAIL: Yp(a nil r!) bei/1e1i. afro <br /> BUILDING PERMIT APPLICATION n <br /> Existing Use of Building: sl�ytq•(.c, ZC/yti/ rH2. Contract Price of Work:$ /6.70 o0 <br /> Proposed Use of Building: 5jrt 6,4y/m. I7' Heat Source: '3as ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached 12:$FR-AttacKed ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New Ertkddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: O <br /> Ct,a41 4G -yorL it-eco - 012 O (e <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION wu <br /> Type of Project: _New _X 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 /> SPRINKLER/'SUPPRESSION SYSTEM <br /> Chemical or Water I 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 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 /> a, ��- � I 5- PERMIT# <br /> M it o r 02)2-- <br /> 0 r/Authorized Agent Signature Dat (Revised 9/23/2016) <br />