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PERMIT APPLICATION <br /> OPP <br /> BUILDINGPERMIT <br /> / PLUMBING /SIGN / NKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 23015 1,00^\704 eve- tireftf °W.-0( PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Nek"-- e' `9-¢a..) TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Z.3O% 1 opikViard (kVA /r 1 <br /> CITY E�C� IAA -'taro 1 STATE � ZIP -01 <br /> OWNER PHONE: ZCJ0-3S - SEM3 OWNER EMAIL: ArAVIAsAAe.6`10✓`ei-') ,\-car, <br /> CONTRACTOR NAME: :kms '. 4 <br /> "b1/ <br /> 1 /� <br /> CONTRACTOR ADDRESS: STREET <br /> `•n-(l( cv- ri(& C e <br /> CITY Y`�\er�.�-Vt1�,C STATE `/14 ZIP /IS 2:10 <br /> CONTRACTOR PHONE: 760-(,S9-' CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): 'E'j" LPL. SS9Sb O CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):0Sc.It' Z <br /> PRIMARY CONTACT: 0 OWNER 'W CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: N,�k- ���� CONTACT PHONE: qZS 3VI- 2C' <br /> CONTACT EMAIL: ,jea-p,t,k; <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 1500 <br /> Proposed Use of Building: Heat Source: ❑Gas LlElectric DOther <br /> Building Type: ®SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel C Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �YI M (74 U 1 PIA.e PrtB, uts\-r.CS b <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 X 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 I Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater i Bathtub Urinal <br /> Gas Piping Boiler i Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove t Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting j 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 /> 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 /> PERMIT# <br /> /1 IZo1—r 0 3 -- D b t <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />