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PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN/SPRINKLER/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: GUI AY.00i tk\-1 b1)(*) t*, (©!, PROPERTY TAX#: 23 04 Mb iO! <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 014&at,�oa� A2� AdP LVfek alit L.L.0. TENANT NAME(If Commercial): you s 't,ptt <br /> OWNER MAILING ADDRESS: STREET ?1 .a.Toy $ hJ _ <br /> CITY $Ct(tque STATE (i ZIP q10 <br /> OWNER PHONE: (1t W%I-xI( 1�_ OWNER EMAIL: <br /> CONTRACTOR NAME: (�Nt\ji;2SAk E4 ►d�C RI ;ci l <br /> CONTRACTOR ADDRESS: STREET '/111/ 1 7Z A/41CITY Lf l✓`✓�/ STATE 1,940/4 ZIP *WWI <br /> (/(/I <br /> CONTRACTOR PHONE: Z.. cf 3/ -jj5 Ol CONTRACTOR EMAIL: Vlealg @u47/VerSa/eei4;:i p.e• <br /> CONTRACTOR LICENSE#(REQUIRED): UA//V / '/ /5'9RF CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): G7.--J-762171,— <br /> PRIMARY CONTACT: 0 OWNER L5]CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: +'*v► �a,b' CONTACT PHONE: "3 <br /> `�` CONTACT EMAIL: V(BP 1/1 01-en 've_ro v/re iqg• colts <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: tS.a4.1Aouck ( +rt0.aS Contract Price of Work:$ t O <br /> Proposed Use of Building: $pawl(: Heat Source: 'Etas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ErCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair IT.I. ❑Sign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF W...(W: 1� <br /> —12i�xr,SUO-6�4 €1.4ci a�,Soluvi.0►\ cr�S t tom.. So�.Nnn.VSSE t'$ \ vS <br /> Ccat et+'r ko D. t t 63P.S vwN.kC.,R-. . <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 Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> I 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 I SUPPRESSION SYSTEM <br /> 'Chemical or Water I No.of Heads <br /> ACKNOWLEDGEMENT::!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 Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> / <br /> 4 0 0 I 127I 441) PERMIT \�\/L' o 5 <br /> Owner!• 'tho . •ent S'•nat re Date (Revised 9/23/2016) <br />