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PERMIT APPLICATIOI4 <br /> A#111Pi4*F-1 <br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> � <br /> J 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: 3 OS Nev$sa;.v 9—, PROPERTY TAX#: &)L- 31578000t 00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: .pet ytd )✓vc.i'(- " 1,-k/-6., TENANT NAME(If Commercial):U/vipt•t, + 6,.14-e4- 174<1,1 <br /> OWNER MAILING ADDRESS: STREET Z3''I 0 N yr lwe "/� i Svi-� (20wc� Nl4x �' <br /> CITY FAV t.Z_ , STATE \A- ZIP q%mit <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: v i^eeli i (p/ZyA✓kil'-1^ <br /> CONTRACTOR ADDRESS: STREET -72--- >A4K <br /> ' ' o n S-A", <br /> CITY Se,At(`.,� STATE W k ZIP C M I Ot <br /> CONTRACTOR PHONE: 206-7,63 — 1744 CONTRACTOR EMAIL: U. b L evneteek,H lia r ,Gfw, <br /> CONTRACTOR LICENSE#(REQUIRED)::� -V-('LCs -1,,5 LI.R 2_ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 04435 0 <br /> PRIMARY CONTACT: 0 OWNER C8'CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: � � Burtal.,-,1 <br /> CONTACT PHONE: 6...'j,63 1,1 t f'4 ecf . Vii <br /> d CONTACT EMAIL: 4,(ZX.6e +tv.,r6-,,et01,11.ia.L,Gey"-,. <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 10r 3)7.a b <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: QCommercial ❑Industrial <br /> Type of Project: ONew ❑Addition CI Remodel ❑Repair L?f.I. ❑Sign ❑Sprinkler CI Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: p <br /> yts}4,1I,u�t1svi, 1- +Wa (Z/ 5p1 -E-5`15+eVn`5i C�VtiCb�rork / d C�Yilles 7 ji17-vSe.f5 <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 #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units 'L- 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 2 Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan I Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> 'Chemical or Water I 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 /> 1% 1..-/10 frj PERMIT <br /> Owner/Authorized Agent Signature Date (Revised 9/3/2016) t/ <br />