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10"t;IXTPERMIT APPLICATIO <br /> BUILDING / MECHANICAL/PLUMBING /SIGN URINKLER/ 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1'126 U((51 x114 ail- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> f ',l CONTACT INFORMATION <br /> OWNER NAME: Csei�1 Ca444.1l 1 'w` TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 19•0. 136X it- <br /> CITY 64 oft ff STATE ditilt ZIP 90?o4' <br /> OWNER PHONE:C20Gt y? '1 • !!S'(4.4) • <br /> OWNER EMAIL: e✓'iitn p((p.Kq ca.v./$1,11 Ca pvtai i.Coy% <br /> CONTRACTOR NAME: 0 (,(JA/ <br /> CONTRACTOR ADDRESS: STREET <br /> CITY - STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: m OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: E i v, Co,N,y(t4'l CONTACT PHONE:hat) (13 y _ GS-It <br /> CONTACT EMAIL: e0vt 0(...Kq co,w(p 4,44&5.yta ty,Lewt <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: PLS'1016wf+A.l Contract Price of Work:$ of 000 <br /> Proposed Use of Building: RCctdc i#,i.l Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: I SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition I lRemodel DI Repair ❑T.I. OSign ❑Sprinkler 0 Demolition OChange of Use <br /> DESCRIPTION OF WORK: add At 1( 44-fh top f ,(4;e(. 6d( la1tr., o/Oft7s is u sf0'rs beth am s. <br /> Rernodcl i-'fGtitin . vpANA eIec,¢r1cIa. vM7'e pium61nj. Add ha,l 44o,,fM dew vltfd.krr. <br /> Oa eleWv-c flAdA ttce. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: % New _ Addn _Alteration _Repair Type of Project: X New _Addn '1C Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #°f Lis • ixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump 3 Toilet Bac.'.w Preventer(Inside Bldg) <br /> ( Forced Air Systems Unit Heater I Bathtub i rinal <br /> Gas PipingBoiler L Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Firepla Wood Stove 1 Kitchen Sink&Disp•:- Grease Trap <br /> Gas Ra a Ducting Dishwasher Roof Drains <br /> Clo s Dryer Hookups Other: Clothes er Medical Gas <br /> nge Hood Wate -eater Other: <br /> 3 / Exhaust Fan ya(leg ,00 I Si (Service/Bar/Mop/etc.) Other: <br /> SPRINKLER:/SUPPRESSION SYSTEM L®„J� �- \I ("'�0 'tea I <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 EverettOficial Use Only <br /> A� --5---5- ( PERMIT161309 x®61 f <br /> •wn' /Authorized A. t Signature ( Dat (Revised 9/23/2016) ' <br />