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PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/ PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> /" ,� CITY OF EVERETT PERMIT SERVICES <br /> ,44 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 /> (Bl of Slack in: nly:t►,lease) ,.., _, PROJECT S TE!INFORMA `IONS `,.,. 3 <br /> PROJECT SITE ADDRESS:32I Z„ ltpi1n a Eye('8{4 GI 7)-1,0( PROPERTY TAX#:055633 250 210 I <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> . CONTACT INFORMATION. <br /> OWNER NAME: *4 17 i'(+,C.h TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET bft9 -ai Groh Pr tl, <br /> CITYY .` r j(- STATE 1 / <br /> ZIP 01k�q� <br /> -(P ' <br /> OWNER PHONE:a0kirClgOIf4• 1. OWNER EMAIL:gegion9ropeov4S <br /> ehDi-Am% .COM <br /> CONTRACTOR NAME: S <br /> R'�Q► �D1�t1C�1lNt PeGtIJa ISS <br /> CONTRACTOR ADDRESS: STREET 116 6 YviaAn (0.. 1te IDS <br /> cz)Z <br /> CITY NAunrot STATE IAa ZIP q!Z1 <br /> CONTRACTOR PHONE:See con1-011110 CONTRACTOR EMAIL:$Pe (Antal 4136 t O <br /> CONTRACTOR LICENSE#(REQUIRED). CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 191,1 <br /> ® PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> tba CONTACT NAME: r j/ (' CONTACT PHONE: LI ZS_'�470 .. aril — <br /> tit p'IeV�1Q (S (A.tC CONTACT EMAILCOSMi4 r c ' Ack,t'5 -.n e+,. <br /> =k 1 . ., aB:UILDING RE MIIT APPLICA Ol!1,..� �, . ; . i;. t ' <br /> Existing Use of Building: Contract Price of Work:$53,ej 22• Se <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached El SFR-Attached ❑Duplex IViulti-Family-#of Units:diVVeg ❑Commercial CI Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel $Repair 01.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: b�S1 _, <br /> ( n f tteS f1) dtAtOitile -Pou,ndikia0 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL,PERMIT APPLICATION `.- A,.. PLUMBING PERMIT APPLicATI NA. <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> A/C-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 /> - <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 Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> - <br /> .SPRINKLEI !<SUPPRESSION*SYSTEM A* , <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 /> 1 City of Everett Official Use Only <br /> i /I , tworkoi niao 1 s PERMIT#6 1 0 3,0,5g <br /> ,, v <br /> Owner/Authorize 4 ,gent Signa ure Date (Revised 9/23/2016) <br /> biz__ <br />