5209 EVERGREEN WAY BASE FILE 2018-05-29

PERMIT APPLICATION BUILDING/MECHANICAL/ PLUMBING /SIGN/SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 j(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 590 9,, E vvr3j' . WA,/ PROPERTY TAX#: 080506O0MO200 LEGAL for new construction: Short Plat/subdivision J Lot No. (attach copy of long legal description) Lc� CONTACT INFORMATION �r OWNER NAME: c IA ?ro f �,- S k TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 10(55 NE /j S+ Sk 901 CITY 6 ,l Ank-c-/ r STATE} (IU ZIP 9800 OWNER PHONE: q a 5- 0-1-05q5 OWNER EMAIL: j Pn•)-F'C��Api i s.enr) CONTRACTOR NAME: I Qui)-C1 C. pwrvm&M f r rt mY\. �T CONTRACTOR ADDRESS: STREET 19 529• 23d Or SE CITY B / STATE .r" ZIP 9 301 CONTRACTOR PHONE: q06-�6O^ $OOO f CONTRACTOR EMAIL: 6 flAL /�,Oj 493► (4), ! 'n CONTRACTOR LICENSE#(REQUIRED): FRAFF1 13 6 K\ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: ��V` Back. � �u1/49 CONTACT PHONE: a06- 6O—g600 ' CONTACT EMAIL: bru,e �3n W e C'mm BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work:$ Proposed Use of Building: Heat Source: ❑Gas CI Electric CI Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Units: ❑Commercial ❑Industrial Type of Project: New ❑Addition �❑_QRe—model ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑ODemolition ❑Change of Use /(_,„ DESCRIPTION OF WORK: EsSIrt " „ ®f YE_ ymq c1'u� to a ��rl ni, paurk�� lot 9rih1 ekvErbly vinjj. ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION pe of Project: _New Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair F • f List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures ixtur• Fixtures Fixtures Fixtures C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Fo .-d Air Systems Unit Heater Bathtub Urinal Gas ' •"ng Boiler Lavatory(Was' :asin) Drinking Fountain Water He- er Refrigeration Shower Floor Drain Gas Fireplac- Wood Stove Kitchen Sink&Dispos: Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hook •s Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER I SUPPRESSIO YSTEM Chemical or Water No. If Heads ACKNOWLEDGEMENT'I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this pe•u it must comply with current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorize. writing from the Building Official before being 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, and I comply with the State Contractors L w 18.27 RCW and 296.200A WAC. / City of Everett Official Use Only PERMIT# � ,lcl 6 ILf —© l,(UQ k Owner A rized Agent Signatu a Date (Revised 9/23/2096)