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"IIP'/*V--, PERMIT APPLICATION— <br /> BUILDING <br /> PPLICATIONBUILDING / MECHANICAL/ PLUMBING I SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> m f 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www. erettwa.gov/perm s <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION Akic\pi <br /> PROJECT SITE ADDRESS: 2,Do q 3e• 54- Z',..)Gt2 '-(d ? 2U4PROPERTY TAX#: oo _Fro TI//OO 9'Q Z <br /> LEGAL for new construction: Short Plat/subdivision Lot No. 5 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: kick trainC LI ne �/ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 12:3 L j N • 14/0 fl-N <br /> Sem u) �CITY yA STATE CYg ZIP <br /> OWNER PHONE: 2 5 9 <br /> U6 .- 5 W/ ' t OWNER EMAIL: <br /> CONTRACTOR NAME: 04/Vj1 i Z <br /> CONTRACTOR ADDRESS: STREET .S:71 rvi .-C--- <br /> CITY i I STATE ZIP <br /> CONTRACTOR PHONE: ') CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: '®OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 206 12$ 3 _ 9yq 7 (1_14345_.Nip! <br /> R iL l kar�e,c h n e/ CONTACT EMAIL: lA Az--i,t ak lc ay i DamGu •Co'-i <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 3( V 0 D. <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial CI Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair OT.I. El Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: - ii: poi.,,1 O lc( 5.I-,oat c., Aza d i" 'tC) 3u Z((Ihc, <br /> /7x. F-143%-11- 51a( C6.Se 5r-aiv+c) aetAc( t-}crtd Rn.cL. <br /> I3 <br /> � y� �_�,s O.f1_ <br /> e S " C)2s �q� LIN 0.0 Vs lily;A (a nch Eric427'"'I-e424-144). <br /> M <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 #of List of Fixtures List of Fixtures #°f 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 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 /> 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# //�/ //��J <br /> 11. _` kra-- ( / a. 6- � / i-1 1W1,1De' �/o" <br /> Owner/Authorized�%f(,'ri` Agent Signature Date (Revised 5/20/2016) <br />