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PERMIT APPLICATION <br /> BUILDIN11IIECHANICAL/PLUMBING/SIGN /II I IINKLER/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: PROPERTY TAX#: 6039300000 <br /> 'zoo <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1-0)1G) Mr ki(A '414 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (`jFA jfirrilirf,r) WON/ STe C )b I <br /> cm( E-V Mr CFI- STATE \JA 21P q ij <br /> OWNER PHONE: 4 2S 2� cj�t) OWNER EMAIL: papa rnCJ 2( n1 n .ccro <br /> CONTRACTOR NAME: l (t 3)'y l C, l ley )rx Contvii 11)rS LLC- <br /> CONTRACTOR ADDRESS: ✓ STREET 2 I I C) Ma sb-y\ csk <br /> CITY EV elf f-1-4- STATE LA/4- ZIP gr?2,b , <br /> CONTRACTOR PHONE: 42s 511 of35 l CONTRACTOR EMAIL: baj p , Dly i i p i c gC °con() <br /> LICENSE#(REQUIRED): CITY OF EVERETT BUSINESSI__ LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: IA OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:`TDy� CONTACT PHONE: 42,s tis R�� <br /> p �\4 M CM U I' CONTACT EMAIL: moil ci Zp sn,C011,7 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Cbcer J c( v fA, )C h .k\np Contract Price of Work:$ 00 <br /> Proposed Use of Building:Q[A ICL stir'}1(C. rNovi�7lVHeat Source: ❑Gas ❑Electric aOther heal'l' o)djyip <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Ocommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition tifigemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler 1 Demolition V.Change of Use <br /> DESCRIPTION OF WORK: A *A <br /> A' a W) j1#F ;V. i AO 7 r ) 1101 Ilr.i" A <br /> v Or: ir - <br /> 1.11:4 --kei.9."/rrS4i44+0-1/÷------q- (4041A Ab <br /> 0061 <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 /> 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 /> t/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 I SUPPRESSION SYSTEM <br /> Number 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 /> i t2- PERMIT# (V / (0117014Own•r/.♦. on ed A t Sign'ture Date (Revised 9/23/2016) <br />