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� PERMIT APPLICATION <br /> #1111111!! <br /> , BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET.EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-2574857 I(E)everetteps©everettwa.gov I www.evorettwa.gov/permits <br /> (Blw or Black Ink Only Phase) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 51004 11)1 t)r/•� W 4rr; ova.t' �7 OPERTY TAX*: On g $4,70Z2�I $Ut✓ <br /> LEGAL for new construction. Short PlaVsubdrvis+on f 1.to I (,q4A/L C oval' ( I F'(attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ht"IAA M. 66(4b 0 TENANT NAME(If Commercial): <br /> OWNER MMUNG ADDRESS: STREET <br /> GTy STATE ZP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 147, k^'P.p G�••tf <br /> CONTRACTOR ADDRESS: STREET <br /> GTS STATE ZP <br /> CONTRACTOR PHONE: ICONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): (CRY OF EVERETT BUSINESS UCENSE e(REOUIRED): <br /> PRIMARY CONTACT: °OWNER Cl CONTRACTOROTHER(Please Specify) q+es <br /> CONTACT NAME: t CONTACT PHONE: f...06..) , -.2-3411 S <br /> p444I;W N L W('CN <br /> .. CONTACT EMAIL: 1,,o# i t "as �n.e 10 -41.0^^" <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Budding: S FP- / contract Price of Wo 5 00 • <br /> Proposed Use of Budding: A-1114‘..If' Thaw L, i"h a`'t- Heat Source: as ❑Electric °Other <br /> Budding Type: CKFR-Detached ch <br /> etached °SFR-Attached ULDuplex °Multi-Family-#of nits: • - ercial °Industrial <br /> Type of Project: ONew °Addition tilKemodel °Repair °T.I. °Sign ❑Sprinkler U6ition °Change of Use <br /> DESCRIPTION OF WORK: /, <br /> Bt4 l /d- ha-J /1"#'11)• <br /> ASSOCIATED BUILDING PERMIT*(if applicable): <br /> MECHANICAL PERMIT APPUCATION PLUMBING PERMIT APPUCATION <br /> Type of Project: _New_ Addn _Alteration__Repair Type of Project _New _Addn Alteration Repair <br /> Fixd n List ofF'xtuns F List of Fixtures f t�ias List of Fixtures Fixtures List of 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 /> Oothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service&Bar/Mopietc.X Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> jChemical or Water I (No.of Heads <br /> AClfNQV4 (GEMENT,t 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 ala permit only authorizes approved work and no deviations therefrom,Deviations must first be authorized In wrttlng horn the <br /> Busdng Oficial before being authorized under any cncumslence.lam the owner,ort am authorized by the owner of this property to perform the work for which application is made, <br /> and t comply with the State Contractors Law 18.21 RCW and 296.2004 WAC. <br /> City of Everett Official Use/Only <br /> 174 PERM'( `2 �,C Jl O <br /> OwnerbAubwAnad Igo� Date Revised 9/23/2016) <br /> Scanned by CamScan <br /> Z <br />