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PERMIT APPLICATION <br /> 477" <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN I 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 I IE)everetteps@everettwa.gov I w4Av.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3325 [PROPERTY TAX#: <br /> - ------ <br /> LEGAL for new construction: Short PIatisubrliviskmii Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION _ <br /> OWNER NAME: ‘....)1A31//j.! TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRE S: STREET 5a.. 4,_yY__ {� <br /> _�_ CITY --�G1GL1--_ —.- �. STATE 1�---- ZIP q��O I <br /> OWNER PHONE: 115 394 3L 33 OWNER EMAIL: L� <br /> CONTRACTOR NAME: (XV' I-I e ,V- 1166- <br /> CONTRACTOR ADDRESS: STREET <br /> 1�i!C57(��� aQ�� �C `Ay �f <br /> i cif), €A,T F -- �`"�J STATE WA ZIP 9'F`c I <br /> CONTRACTOR PHONE:I--35 259 OS CONTRACTOR EMAIL: dUfraidI e. ir,:kilf1Vl eati4S . CCl yl <br /> CONTRACTOR LICENSE#(REQUIRED): C_mvi- .rvl.k1S-7idf1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): I LgCC( <br /> PRIMARY CONTACT: ❑OWNER t f CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: r, • CONTACT PHONE: L1 a5 (� �o <br /> .{9 Ue-) CONTACT EMAIL: deb 1)l,e D c yU?Ql-lflto Mi <br /> (((( BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: S 10 L,3 o"Z• 9 9 <br /> Proposed Use of Building: 'Heat Source: ❑Gas YElectric ❑Other_ <br /> Building Type ❑SFR-Detached ❑SFR-Attached DDuplex ❑Multi-Family-#of Units Commercial ❑Industrial <br /> Type of Project: :New ❑Addition DRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> IA 54-edil c 0655 kat p <br /> -I <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 #of — -- <br /> Fixtures List of Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures <br /> A/C-Air Handling UnitsHeat Pump Toilet <br /> p Backflow Preventer(Inside Bldg) <br /> Forced Air Systems _ Unit Heater Bathtub <br /> --- Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink a Disposal Grease Trap <br /> ...-.. <br /> Gas Range <br /> Ducting _ Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: ^Clothes Washer Medical Gas <br /> - <br /> Range.Hood _ Water Heater _ Other: <br /> Exhaust Fan Sink(Service/B;--,r/Mop/etc..) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT I have reviewed this application and confirm the information contained herein is true end 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 properly to perform the work for which application is made. <br /> and I comply with the Stale Contractors Law 18.27 ROW and 296.200A WA C. <br /> City of Everett Official Use Only <br /> PERMIT#r!? � - l .S i` C' l <br /> 'OvlAssthorized Ayenl,ignatiire <br /> Dale (Revised 9123/201(i) <br />