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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING /SIGN /SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue'or Black Ink Only;Please) '43`014Ett SITE INFORMATION <br /> PROJECT SITE ADDRESS: '9/52 I^C`T eme., 4-(l /Elk: 9574:13 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT I N FORMATION <br /> OWNER NAME: S ArT4Dhoti V��J�S j C a_c,Fy TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET .40 32. F6-71161246.- <br /> CITY L'✓D- STATE lit> 4 zip 9SZo3 <br /> OWNER PHONE: zi25 -4'52 —3111.7 OWNER EMAIL: Fps 51—(2, _gks p ' ct)ciCN Ct3N1Cr957„, <br /> CONTRACTOR NAME: 4UDkri-/- ' o2 c AA) ,UG /Al e. <br /> CONTRACTOR ADDRESS: STREET R.6. 1344 L S 13 <br /> CITY 'LS_ STATE ( j A ZIP 9 9.09/ <br /> CONTRACTOR PHONE: yaS—e-tv - 65q•( CONTRACTOR EMAIL: d4ry n 6 N 51,0re <br /> CONTRACTOR LICENSE#(REQUIRED) N®R p 17/3 /V CITY OF EVERETT BUSINESS LICENSE#(REQI <br /> PRIMARY CONTACT: grOWNER ❑CONTRACTOR OTHER(Please Specify) ST-J&= Al(l41 G(L.L>n/ FAC/tu7`Y ,v tPU19654. <br /> CONTACT NAME:NA� CONTACT PHONE: 4L 5 —�, d ••— /gee)? <br /> / --bz; CM4'C-Lf� CONTACT EMAIL: m )slPirW) Ce"t'rok rc6Y, <br /> BUILDING-PERMIT APPLICATION w <br /> Existing Use of Building: Contract Price of Wor • \%%.&) O O <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Elec nc a• er <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: g - $!a j p/AdtG „1/4)6.....ctisPh'/GLT > Li {x192 k/4f4 <br /> Lor 4/vD 7:).F_) u2=w►4y* <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 st of Fixtures #°f List of Fixtures #°{ List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump Toilet ackflow Preventer(Inside Bldg) <br /> Forced Air Systei s Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> 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 Ho. ups Other: Clothes Washer edical Gas <br /> Range Hood Water Heater 0 her: <br /> Exhaust Fan Sink(Service/Ba Mop/etc.) Other: <br /> SPRINKLER/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 /> /74A-1/4-C7 174-1 / 7 PE , r <br /> • Owner/uthorized Agent Signatu Date (Revised 5/20/2016) <br />