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PERMIT APPLICATION <br /> /1171-4. BUILDING/MECHANICAL/ PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: D A CA-C% P QE. cS�. PROPERTY TAX#: 'v O13t°OC)DO© 2,OO <br /> LEGAL for new construction: Short Plat/subdivision Lot No. _ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 3Cot- {)p1NG`t ULA TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET litwir 6I1!1 <br /> CITY 1UA0Qle,'('f STATE tp.....jA ZIP <br /> OWNER PHONE: Litg7"273'051,..k/ OWNER EMAIL: J O�ZG,w p, co rti(� ��Nffi <br /> CONTRACTOR NAME: Q yV f J- <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR '®OTHER(Please Specify) fr Pt (ATs) ( DES(G NCS <br /> CONTACT NAME: Al �xoFtcw r v n' CONTACT PHONE: 7..0G,-.143 y_ U( <br /> CONTACT EMAIL: KLG X� •V 1'.N.P,1S: 1.01,4 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: L.7r(L, Contract Price of Work:$ LI 0,600 <br /> Proposed Use of Building: S•rtZ Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached IRSFR-Attached 0 Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New ❑Addition ErRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition DChange of Use <br /> DESCRIPTION OF WORK: f,N)..rEse,b,... R.r�-rwD�l-j h NI 02. C4,)vFl..O PFrr CA1Lj <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 IZAlteration _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 /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting I Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: % Clothes Washer Medical Gas <br /> Range Hood (t) Water Heater Other: <br /> Exhaust Fan \ Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water 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 /> i ' /7 31��1�� PERMIT# b cttJ V 01 <br /> Owner/A,a�orized Agent Signature Date (Revised 9/23/(200116) <br /> 4 <br />