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I PERMIT APPLICATIO• <br /> filiP DUILDIIIO I MECHANICAL I PLUMBING I SIGN,SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> NoilaY <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 5613 %4 191 SE. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: .0t�-rPYrt Z r, Alkr ,( TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET B l J 411 Pl S . <br /> /� <br /> CITY Evpjr, ,M STATE ��. 9'. ZIP O <br /> OWNER PHONE: T•BSSre.A;QSer- e14---C,4S, Con, OWNER EMAIL: I -3(00 -Site> -10 2, <br /> CONTRACTOR NAME: f 7 k)A.. CervS4-y-O-t,.-t LLC', <br /> CONTRACTOR ADDRESS: STREET 3Bge>ti 11944- S i� <br /> CITY i-ij.:.,-,L,... STATE S 10 ,y�g ZIP� OWO <br /> CONTRACTOR PHONE: Z(9-473-91(fl'L CONTRACTOR.EMAIL: 1LWt 4-q b el t',)p'-41 j , 051✓- ,/ <br /> CONTRACTOR LICENSE#(REQUIRED): (0O Li' .2-01 (a77 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 4' <br /> PRIMARY CONTACT: 0 OWNER [If/CONTRACTOR D OTHER(Please Specify) 20-1 JL <br /> CONTACT NAME: CONTACT PHONE: 6,-x-1-7 3-9 5(t)- <br /> 4 U.$���J� CONTACT EMAIL: 11,W-6,4 i I ttfey el.,c: I. Con . <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: S.nc,It P4,1 /1P-e0tnc-4-r Contract Price of Work:$ 411 <br /> Proposed Use of Building: 115/e 1;, ,Ii/fie „9c.;<Heat Source: @Gas g]Electric @Other <br /> Building Type: @SFR-Detached @SFR-Attachedplex @Multi-Family#of Units: @Commercial 0 Industrial <br /> Type of Project: CI New @Addition El Remodel IRepair DTI. @Sign El Sprinkler El Demolition @Change of Use <br /> DESCRIPTION OF WORK: (ift)N W;,I l i �� 1"�; e. \NofliL,i,p,�1-eA� \D.- 5:114....S t I t0,"s 1,w�sG,.v <br /> 1� ', if Napa" <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 #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump 3 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 I 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 a. Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I No.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 /> .,•''''Z____ ___ S. / s ' / ? PERMIT# <br /> 51112 -013 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />