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grrPERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING I 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 /> il .x ._ PROJECT SITEiINFORMATI.ON <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: <br /> 1228 t 1k�w Ave, <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ;CONTACT INFORMATION <br /> OWNER NAME:-Frq,,i,k +- Ggvtr (j:vl. Oa i AC TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 122.$ £«1(e w 4Vc, <br /> CITY V C.vc"t{- STATE W 6 ZIP 12-0 3 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME:M t,t-A 44(c I-kc.+{';.,.r- d-.essay 6,v I;in yc X.vt c. <br /> CONTRACTOR ADDRESS: STREET 351 S 1/:— Juv- 56, <br /> crry I K k $t c%rc n.1' STATE (,✓v¢ ZIP R 8 2-S-1 <br /> CONTRACTOR PHONE:11257-3311-5100 CONTRACTOR EMAIL:ch.;t><f�uEFort.b1cL.«+i..).wi.dc.rr,(!,3;.,c_ca.4. <br /> CONTRACTOR LICENSE#(REQUIRED):AFFO P.1(11 I p K E CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):es-052.2 !1 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L/ _52 3_c(7`{s <br /> Gl r..r t,e-5 6 v cA. '- CONTACT EMAIL' <br /> chv�.k@ a fire.-d<L/ch�w-f:n�•t:hslc�(��fr. r�<.c ow, <br /> :taztavtgzaudvdaawi , ,. ..;, oj.m.0 ING PER.IT APPLICATION <_ <br /> Existing Use of Building: Contract Price of Work:$ 1/618-0 <br /> Proposed Use of Building: Heat Source: ❑Gas SElectric ❑Other <br /> Building Type: ❑SFR-Detached OSFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ORemodel ❑Repair DT.I. ❑Sign OSprinkler 0 Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> 6-171.61--1 41 v. et•��".r%,_ -r u.r .., �,.-e_ -C., a, G(eefrrG -rU✓n4 4l't <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> .12 ,11:4# HANICALjPERMIT APPLICATION F , „ ,'.,r PLUMBING:PERMIT APPLICATION w,„„ <br /> Type of Project: New_ Addn Alteration _Repair Type of Project: New _Adds Alteration Repair <br /> #of #of #of #of 1 <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures = <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> l Forced Air Systems Unit Heater Bathtub Urinal ( <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain i <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap 1 <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas I <br /> Range Hood Water Heater • Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> ( <br /> rniikAORLISOcCER.ft SUPPRESSION SYSTEM:; 0 <br /> Number 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.lam 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 /> ���� �� /- <br /> �� co,en A fid—'-1 PERM ( z\ 0�05� <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015)` <br />