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PERMIT APPLICATIO <br /> BUILDING/MECHANICAL/ PLUMBING /SIGN('RINKLER/ 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(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: V L4 C..) CaS't 'O L.P 614 G I.- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: C.c I (JJ S/IAG)U`( k6Lr- TENANT NAME(If Commercial): <br /> OWNER MAILINGA DRESS: STREET 4ta_ViLtr. U"6I�l/ <br /> �2 112 01-` CITY STATE (AM ZIP *01). <br /> lcOWNER PHONE: / DOWNER E�MrAIL: <br /> CONTRACTOR NAME: 0'0 aCtf-U J C crt v zrJVC Si`l Uc� <br /> CONTRACTOR ADDRESS: STREET , / ' 112-- /k/L Ai-- <br /> CITY r, ;♦ E.-_. STATE 06/4" - ZIP 11470 <br /> CONTRACTOR PHONE: L% ,fir CONTRACTOR EMAIL: ��j^t/GJ' g � �r1�.r`, <br /> i (!!` <br /> CONTRACTOR LICENSE#(REQUIRED): ''+ I no <br /> CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME• CONTACT PHONE: I r/ (/`i ,r,,i I <br /> 1-f t r liV I V yc `k c 1 Mk CONTACT EMAIL: �.' ; (l M4K .. G94,061:/tet— <br /> U <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ n 1,)V 0.3 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> MektOnWL' <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 /> I, A/C—Air Handling Units ( Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> t Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> r 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 /> r Range Hood Water Heater Other: <br /> I1` Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water 1 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 br fore 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 •mply wit pe State Contractors Law 18.2 RCW and 296 00A WAC. <br /> ,:jq ( City of Everett Official Use Only <br /> 1/4 <br /> Ilh <br /> f�V�L�1 ��+ r PERMIT# <br /> Ow - .rize. •gent Signature DateRevised 9/23/2016) <br /> Lt 406 QE t-n 4f Vet702 • G39- <br />