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PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 'OW, <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 /> (B>lue,i B Ink O my Please)= :PROJECT SIIT€ INF 3R ATION <br /> PROJECT SITE ADDRESS: 3620 $14OAhDWA1A'C . E�g RSR' PROPERTY TAX#: Of.,f738`gC1ZOO <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT I ORMATION :. <br /> OWNER NAME: VA vN 1 N\L LE pexpt(L-r j E LL GTENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET p O P )C. 598 `!;: <br /> Fe-2E----r CITY \4\ STATE ZIP q 9 -O o <br /> OWNERPHONE: y s - sin - '°7SC'�(, OWNER EMAIL: Qclam e Siadik...melovVe.t.S , cory-) <br /> CONTRACTOR NAME: /F V CoWSr*PctiD// <br /> CONTRACTOR ADDRESS: STREET 8105 SA p4 W y AVc,/ <br /> CITY 5t/sR577-' STATE VA. ZIP 38203 <br /> CONTRACTOR PHONE: OS"--3SS-S"'SV 2 CONTRACTOR EMAIL: ✓/ e a pri Jejthert,Onsitvaio J.tom <br /> CONTRACTOR LICENSE#(REQUIRED): Gj MC- f1913 CITY OF EVERETT BUSINESS LICENSEI #(REQUIRED)t 23 Cr 1 l <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR E%V6THER(Please Specify) <br /> CONTACT NAME: \vvkAm Ttiopk,k5i AW CONTACT PHONE: <br /> 425. a,51 . p&a,( CONTACT EMAIL: /t/�/GLIGSCG / 1!J"GJe-,4.net- <br /> Jilt <br /> s. <br /> t l <br /> "BLflt lllNG PER MIT APPL:ICATI ": <br /> Existing Use of Building:WMM e'tatoo 101/0/6.59-Ft vi RS Contract Price of Work:$ 376 t 160,0(0 i � <br /> Proposed Use of Building: i. (S'a$LE thausS$,kc??V/7769 Heat Source: ❑Gas ❑Electric ❑Other __rig <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ■Commercial ❑Industrial <br /> Type of Project: ❑New ■Addition ❑Remodel ❑Repair DTA. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: d Qpiripe pp k st4gLE evs s fc6 . 3, 1300 S.F;/i$Do,TI p/IV- r SrvRY <br /> w/1N l$' ,1631/ Pgy/j&-SPACES f C.AIVDScef"VG, Na A�v�a. ��k�u s <br /> 8v1441146 s I W/ IAJ V 4-1-LQN- r- / ze V-' *AO yt#�IA, U7 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IIMECHANICALPERMIT APPUCA 'ION PL!mt.tit G PE tMIIT AP,,.PLICATION _.. <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 F' ures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units Heat Pump Toilet Backflow venter(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urina <br /> Gas Piping Boiler Lavatory(Wash Basin) ' king Fountain <br /> Water Heater Refrigeration Shower ( ' Floor Drain <br /> i ,Gas Fireplace ,Wood Stove i Kitchen Sink&DispolpaI, tl / Grease Trap <br /> Gas Range Ducting Dishwasher ---) ,---- 4 Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washed j Medical Gas <br /> Range Hood Water Heater i Other: <br /> Exhaust Fan Sink(Servic-.:ar/Mop/etc.) Other: <br /> i <br /> Chemical or Water I No.of Heads <br /> ACKNOWLEDGEMENT:l 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 /> �f k—: 3�/7 <br /> PERMIT# A <br /> Owner/Authorized A ent �f�' Date <br /> (Revised 9/23/2016) <br /> r o DS <br />