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PERMIT APPLICATIOM e2P":77BUILDING/ MECHANICAL/PLUMBING/SIGN /SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits (Biose or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: t Cl.'a c cke tn.vk S1 Eva riG hl✓I 61S72-CA PROPERTY TAX#: C036323947 t5O 9 6549 LEGAL for new construction: Short Plat/subdivision a t)MIM it 4- Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: A46,,rtl 1<g :*.oVAf TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET2 t CO 156 Sfi f , Clnk ReiA, v We- STATE A/t.i7 ZIP 'o02,,d OWNER PHONE: goV"' it " (0a13 OWNER EMAIL: inn. zsmei, c t 6,1ofi�.L�5'1'•VI i'I" 'CONTRACTOR NAME: $ R L/P J (e if Eve fee //J S']Ce ifi5 /,/tet. A.Ape„ CONTRACTOR ADDRESS: STREET f/3a A-cared 1 •fr'/-e, s•`1-e,- 10k CIN i/1.UhavviiS✓A STATE til/-A ZIP 121.O CONTRACTOR PHONE: Li 2g.-..Sia--7 860 • CONTRACTOR EMAIL:ace.,pro(( vv/i;>evg�,>.-t;-tivvi,cvvrl CONTRACTOR LICENSE#(REQUIRED):SF 1vP1 S B7 6 0 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):0,5" R(zS PRIMARY CONTACT: 0 OWNER .16.OONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: { 1 CONTACT PHONE: !L{2 7C4_7,t,Q Dcuj~,CI t cLtfl� \I\ CONTACT EMAIL: CJCt,.vitt"ti‘cz 5e.„4„,Arse)P.-'v `ff t/✓a:Coi/I/I a BUILDING PERMIT.APPLICATION Existing Use of Building:'1\ J - (.Mort;.}'f AL54.46e_ (lam?)esei Contract Price of Work:$ 5Imo' co Proposed Use of Building: c,E.,1,ne ci S V;, Heat Source: CI Gas „Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ,'6uplex ❑Multi-Family-#of Units: ❑Commercial CI Industrial Type of Project: CI New DAddition ❑Remodel Repair ❑T.I. ❑Sign ❑Sprinkler CI Demolition CI Change of Use DESCRIPTION OF WORK:-1I AA ewe yew _r__ /' _S I O vtew yt^.w� C( ' • ASSObIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: New _ Addn _Alteration ,Repair Type of Project: _New Addn Alteration _Repair Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures I NC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal I Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain IGas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains 1 Clothes Dryer Hookups Other: Clothes Washer Medical Gas i Range Hood Water Heater Other: a Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER/SUPPRESSION SYSTEM I Chemical or Water No.of Heads 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 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 Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only r Till Owner/Authorized Agent Signature Date (Revised 9/23/2016)