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PERMIT APPLICATION— <br /> BUILDING <br /> PPLICATION"111110**/%;-----4BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> .7 ' 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-br Black Ink Only:Pleascj`' `PROJECT SITE INFORMATION ''" <br /> PROJECT SITE ADDRESS:14130 Cc)Co531(Lp Wick L PROPERTY TAX#:(DRG,ts---7-1 3 L1 oc <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> .fly' � _ _4 CONYACT.INFORNIgTICON' `; <br /> OWNER NAME: )i5 M. ccl(icbIt)it ^ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 42,6 to al, `Z,d. .E5i- I <br /> CITY Eyte: STATE 1A/A- ZIP ®/Fi.t1 4- <br /> OWNER PHONE: ( ) /43) . I J I OWNER EMAIL: �Jv�O-( L&LA ( O Ut[Oo L&(Y\ V <br /> CONTRACTOR NAME: KlitiS q 'i i r ftc <br /> CONTRACTOR ADDRESS: ° STREET (09 -1L ' S')h <br /> S IA)< SUi k C- <br /> CITY LA n STATE to,1A- ZIP(4805 42 <br /> CONTRACTOR PHONE: (Lin) a- s1S 3 CONTRACTOR EMAIL: eni d&col.Q6.)}Gj( J 4,l , Ca IA. <br /> CONTRACTOR LICENSE#(REQUIRED):J(I KIC1S1I 1 bLiy jPc CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O ' <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (0) ?� _ 66057 <br /> C1\ \r 5 QLf..( -( 1161\ CONTACT EMAIL: rh ft c L.. Li -4 3 eb-C921 <br /> BUILDING PERMIT APPLICATION lJ <br /> Existing Use of Building: Contract Price of Work:$ bEI <br /> Proposed Use of Building: Heat Source: KGas ❑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 /> P(acCn oao &UCt xac t-„ 4- cock( A-ea.:10- ( -e to( tic. <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 /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> I Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> I 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/SUPPRESSION SYSTEM <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-sing a/{ orized nder a circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and! . ply w' the.ate f tracto I L• 1, RCW and 296.200A WAC. <br /> / City of Everett Official Use Only <br /> �- Ire PM NOC 010 I. ( <br /> Owner/Authorized Agen Signature Date (Revised 9/232016) <br />