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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> 47 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.everettwagov/permits <br /> P.ROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:svL w d as 014 &`VNl�••/_/P-ROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> :,. ..,,_�! .n ::CONTACT INFORMATION _ + 0? <br /> OWNER NAME: CAS tilt us t A4 TENANT AME(If Commercial): <br /> OWNERMAILINGADDRESS: STREET NOLeSt46 C� <br /> 7-223 1(2,1' 4 HOZ d �j�'1 L—' "E! 014- 7 e(2 ( STATE ZIP <br /> OWNER PHONE: ([ 'J b •(�.... . ()INNER EMAIL: nveig t ). coN1 t nd- <br /> CONTRACTOR NAME: SSI ;az <br /> C /�( moll 1��. G _ <br /> CONTRACTOR ADDRESS: STREET 222 (1 AVP-- <br /> CITY E STATE U/,� ZIP :✓)J. <br /> CONTRACTOR PHONE:(920 bel CONTRACTOR EMAIL: t 'kiiim (0Ct S +7 2,e <br /> CONTRACTOR LICENSE#(REQUIRED): 92.1 g8 CITY OF EVERETT BUSINESS LICENSE#(REQUIREI �r�'S <br /> PRIMARY CONTACT: 0 OWNER [, CONTRACTOR 0 OTHER(Please Specify) � <br /> CONTACT N•�E: v CONTACT PHONE: 11;24. 1121:3148? <br /> Jilt( e ► 'V CONTACT EMAiL: 1 GC/! 1M/rkir "t/ CeMe-1 <br /> BU,iI.DINGPERMiTAPPLICATION" ' <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New ❑Addiitiion ❑Remodel ❑RepaiirCIT.!. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF ` 70 /�Wir0 <br /> 2 44104 �� WIVE <br /> pi-7,7-,0/( <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANXCAL PERMIT;APPLIiCATION ,_, <br /> ,,,,, ,;, tPLUMBING;PERMITAPPLiCAT,10NO, ::; <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 i <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: idffte litrILI''-f-yr:s <br /> B/d <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: ¢ <br /> iSPRINKLER;l SUP,,PR-00)0,N:'ISYSTEPASintl <br /> 1Number 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 /> curie, ederal,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 /> Buil ing'Ofcial before bel:g authorized under any circumstance.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, ' <br /> an.I co/774 with the Stat i Contractors Law 18.27 RCW and 296.200A WAC. <br /> Citytyof Everett Official Use Only <br /> r <br /> ►41iN .04 11 PERMIT# �( ©�„®(, — 1 1oit ylO� <br /> Own �� .wirt- � 'I1 `re Da' (Revised 10/12/2015) <br />