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PERMIT APPLICATIO <br /> "Illid-"-'g <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ��M ' 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJWITE INFORMATION <br /> PROJECT SITE ADDRESS: 4i. ! t.\/ PROPERTY TAX#: <br /> LEGAL for new/ construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> "TWO/77 U,44S01^- CONTACT INFORMATION <br /> OWNER NAME: E'i.2r etl- Ct,""4,,t '15; Co/lam TENANT NAME(If Commercial): A-Pri r'6_, <br /> OWNER MAILING ADDRESS: STREET 3.6tV Tbad /� 7.6)0 /(/, &t P edGj <br /> crrY Cvore—el— STATE wA ZIP / <br /> OWNER PHONE: 2/2c 3 ' / /- OWNER $ <br /> OWNER EMAIL: ra o.'• @ e ,e,G "e.L - zaia <br /> CONTRACTOR NAME: • LigPM I I I Ell.1 I i <br /> Ai <br /> CONTRACTOR ADDRESS: REST ' <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR MAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): `` ":w"K) lW \`I VERETT BUSINESS LICENSE#(REQUIRED)5.66- <br /> 6::2 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) A 21`61,"lei <br /> CONTACT NAME: CONTACT PHONE: 206 f ZD 6 3 y8, <br /> ve.rry 04 ho r CONTACT EMAIL: J'� ,.,1/4.0....©a-1 p� /'.bM . <br /> / BUILDING PERMIT APPLICATION <br /> Vee,r <br /> Existing Use of Building: j't,IpptL ,jtz 1-fZ) ) Contract Price of Work:$ 4 ri ? 1(9 <br /> Proposed Use of Building: vcac,�t`.,oc/ e6tGad tbA. Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑__Rep'air ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: T6`�� AvOM 'n-� Ce4 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): *NUM(/'kef Otaf ► Ct <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 /> A/C—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 I 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.lam the owner,or lam 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 /> ' PERM/217City of Everett Official Use Only <br /> gDq <br /> a r-r/Aut ed ,�dj <br /> ✓Agent Signature Date (Revised 9/23/2016) <br /> 40 <br />