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PERMIT APPLICATION <br /> BUILDINECHANICAL/PLUMBING/SIGN / UHZINKLER/ DEMOLITION <br /> grr . CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> Blue o <br /> ;: .... .Y : ) � PROJECT.SITE INFORMATION <br /> (�„ •,�._ r Black Ink;Onl Please , <br /> PROJECT SITE ADDRESS: a 9..O"I. 6 .' s jJ P Lh 16 PROPERTY TAX#:00 4 i T-Bd doSo a yG O- <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION r <br /> OWNER NAME: m A R-r I V.g. ' am, ,� , aD q I u£' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREai 9- 3 I I Tr- STATE <br /> �(L. o Q b IZ <br /> CITY C t Q£ L 1- STATE (,y /a ZIP Ci S'a 03 <br /> OWNER PHONE: L{a...5-3 5 (�--q I OCA OWNER EMAIL: <br /> CONTRACTOR NAME: 1-.IFI U 6 Vi Ifo 1/i 's8 LLC <br /> CONTRACTOR ADDRESS: STREET as 01 5'�J9 $t <br /> CITY L Ire i`p tf STATE A ZIP C110-0 ( <br /> CONTRACTOR PHONE: LI 1.5-1 9 3-- 5 fj 52- CONTRACTOR EMAIL: L O G S G t O i-r s t.IQ't" <br /> CONTRACTOR LICENSE#(REQUIRED): I.i ioGUN y/AI q CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):0%,02 <br /> PRIMARY CONTACT: 0 OWNER I CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: q- j -2.A 3.5 es2-- <br /> G". LANG a j CONTACT EMAIL: <br /> LCC s�CQirn(F,S'F t NO' <br /> BUILDING PERMVM.IT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 760 00 0.0 D <br /> Proposed Use of Building: 0(L Heat Source: E}Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached f17 R Attached ❑Duplex ❑Multi-Family#of Units: El Commercial ❑industrial <br /> Type of Project: LTlew ❑Addition CI Remodel ❑Repair OT,I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use - <br /> DESCRIPTION OF WORK: co,,..s 1-Q T- ..4- N( a 3C 12 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: Zew_ Addn Alteration _Repair Type of Project:V-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 4, Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater i f Bathtub Urinal <br /> (p Gas Piping Boiler 1- , Lavatory(Wash Basin) Drinking Fountain <br /> i''.- Water Heater Refrigeration 9. Shower / Floor Drain <br /> / Gas Fireplace . Wood Stove / Kitchen Sink&Disposal Grease Trap <br /> / Gas Range Ducting y Dishwasher Roof Drains <br /> t Clothes Dryer Hookups Other: j Clothes Washer Medical Gas <br /> / Range Hood Water Heater 1 Other: <br /> 5 Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> r• .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 /> PERMIT# <br /> C [ b (o-- CY1 <br /> Owner/Authorize gent ignature Date (Revised 5/20/2016) _ <br />