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` 4L17. <br /> PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 - 2N sl 1100/1 <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 Pleasie, ;A.- PROJECT;.SITE INFORMATION. , ;i:i "' r-:-", ;:t , u, ,}: <br /> PROJECT SITE ADDRESS: 02Q/1 &Pa-pct A U e...-. , PROPERTY TAX#: 00 113 47 L{i-L2,7 OZ)9')Z) <br /> LEGAL for new construction: Short Plat/subdivision V Pi a,6 Lot No.(1'/0(attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: He j all S CO tt TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 401'7 G--rcc,r4 Cl., A-- a <br /> CITY 1 Ver e'Lt., STATE uJ 4. ZIP i ga D/ <br /> OWNER PHONE: 9a 5 - p L L{ [- Q'73 R OWNER EMAIL: he; Gc Sc D c2 C oMca,-f', ivet <br /> CONTRACTOR NAME: C,1254-6Y1 i 1)4_12 e....12,50 �ei. 5 ii 6./ L_.Lam, <br /> CONTRACTOR ADDRESS: STREET a 8a I ()CO-'44C1 44 if e. NE; 41.5oa. <br /> CITY j3 eGUe Ia0` STATE LL) /' ZIP C/57004 <br /> �c <br /> CONTRACTOR PHONE: ote- oGy- 1 I (7 CONTRACTOR EMAIL: m uyem eivTt. Q f&,ftrni Tito <br /> CONTRACTOR LICENSE#(REQUIRED): C OSTOP D 853.Dc CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):di-45YN`C <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) 113D <br /> CONTACT NAME: CONTACT PHONE: Lia5 — -'L 41 1 -0-13 <br /> 14e j V 5 cz 6- CONTACT EMAIL: h e vft 5G Z? Q G o t'hGGQ1/4.5 . /1/e' <br /> IBUILDING'PERMIT APPLICATION.`_ i -` r. <br /> Existing Use of Building: S jl�( ie_ F( on i.1:_y. 1 ���,„ 2 Contract Price of Work:$0 ADi 00 <br /> Proposed Use of Building: 3 jiy 91 e, Fawn1 4 f j-t$W. feat Source: ❑Gas Wlectric ❑Other <br /> Building Type: %SFR-Detached ❑SFR-Attached ❑Multi-Family-#of Units: ❑Commercial CI Industrial <br /> Type of Project: ❑New ❑Addition 0 Remodel Xlepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Frow-F <br /> t „ n i ' 4._&04 5 i _I ,n ��G <br /> ‘ <br /> ° 1112F <br /> ASSOCIATED BUILDING PERMIT#(if applicable): C 1( <br /> MECHANICAL.IPERMIT APPLICATION PLUMBING PERMIT APPLICA1M* „ _',`' <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New Addn Alteration _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 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 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contra 'rs Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> • <br /> PERMIT# <br /> wner/Authorized Agent Signature D 1e (Revised 9/23/2016) <br />