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II'' 1I 1'1I OLT PERMIT APPLICATION 11I IIII <br /> BUILDING11RECHANICAL/ PLUMBING /SIGN /SPRIN LER/ 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: 35 T VIETMOR.t. MI6 16201 PROPERTY TAX#: 00043 697 ct ZC)O 900 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (•.. �j(�P\T pr3-1,C-S`I TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS:\OCTREET2•/ t 'S 31 <br /> CIN1 ,11Q\,K.2LAN-1) STATE ` ZIP <br /> OWNER PHONE: 2_0 C-s 2:Z-7 g6S'y OWNER EMAIL: '(.) W) RAT t-+MPs)l_ b C-O yM <br /> CONTRACTOR NAME: ?L.)5 i>t/VI..o urn or "O<c;,I VPC (O <br /> CONTRACTOR ADDREss V1O5TREET 50 T M G, <br /> CITY PtC..0 Nl a STATE\f\ ZIP 6443 <br /> CONTRACTOR PHONE:253 737 444 ( CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSEE/#(REQUIRED): �LvGE p 7 CIS CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: z.0.6 22,7 471 ,5---4 <br /> Kt t1PcP-Ec $ CONTACT EMAIL: 6 NI 05R Pa 0 (9-m6o L, 6 cloAV\ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: \1'AZ-NK `T Contract Price of Work:$ &Wd), <br /> Proposed Use of Building: t' e. jY p L1 M.OP'-3 Heat Source: OGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: / ❑Commercial 0 Industrial <br /> Type of Project: :New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler K1 Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> p /v OLA.7 LUN 6-5(1S1( t`E &. a L t s-Ta-U G7 U 2-C A-&)U-r 800 <br /> e_ov G-e w iTtk i u-c bots m, 31k--. d Lori- ith--TT( C <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 List of Fixtures #of 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 /> 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 /> PERMI 011., 0014 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> 999 IJ <br />