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grr PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/PLUMBING 1 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)everettepstvdieverettwa.gov I www.everettwa.gov/permits <br /> (Blu+le or.'Blaek Itnk Only AI+E se . PROJECT:SITE.INFORMATION <br /> PROJECT SITE ADDRESS: it 2'Z >4 ($2'1 17rO a clIA)ay PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT:INFORMATI OM":. <br /> OWNER NAME: Aka� Dud-% TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (o3 12 'S. 2_9 T14 )L ' //� <br /> CITY Ai�bi..rv1 STATE yvA ZIP q TOO OO <br /> OWNER PHONE: (2©6)3o-I - /4,s-1 OWNER EMAIL: Vl rui O to c-1,l e ) JIO° COM <br /> 1 <br /> CONTRACTOR NAME: UW / <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 3KOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (r2z67) 3 O-? - /4,s- <br /> 1\ ate'1 CONTACT EMAIL: Y1 Q c ✓ O(,k(j1 Q c 00, COW) <br /> -i <br /> J <br /> BUILDING PERMIT_APP.LICATION <br /> Existing Use of Building: 12.E---t-ot i I Contract Price of Work:$ 3�OO O.00 <br /> Proposed Use of Building: t�€_1 0,i I Heat Source: ❑Gas Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition 'Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: . <br /> 2e o',fe. -ex ch vs119I bfCk- o14cl tiisf'11 pr-e✓&' Lc. �c�vs FIs 'Tho± <br /> mei-c 14 1'h.c_ O.p p rO used d r-4 ,i vt0 S- <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 /> 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,:!S.UI PRESSION YSTEM <br /> )Chemical or Water !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 authoriz:•under any circumstance.I am the owner,or tam authorized by the owner of this property to perform the work for which application is made, <br /> and t comply with the State . i . t,rs Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> /2-1// PERNtO2J-09-6 <br /> Owner/Author' Agent Signature Date (Revised 9/23/2016) <br />