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PERMIT APPLICATION <br /> ,,4,,,,,, g:,------ BUILDING/MECHANICAL I PLUMBING/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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:Vl`12.CA itivtlei V t. Ever at-, W A N023 PROPERTY TAX#:ON 203DD000 401. <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Jeai 5eA. A TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ('c I?. 0[ ,u•N O) C# <br /> CITY .V `/t 'e, STATE 1,A/ ZIP g-n?i <br /> OWNER PHONE: 6 31P. Z- 14-5q0 OWNER EMAIL: huh C hib ieSSerio zvjnia/ /.C6141 <br /> CONTRACTOR NAME 3 Gi �1 s 191Lanbi� '}� S/ <br /> CONTRACTOR ADDRESS: STREET -7 <br /> �2ZifV� �?S� S _ <br /> CITY f�,tA>t�YSTATE v r '' 21P g i50 <br /> CONTRACTOR PHONE:42c c{ % - -73 j CONTRACTOR EMAIL: Ifsaly+ SCGlmr l.fC'UmbiIic)-Co'1 <br /> CONTRACTOR LICENSE#(REQUIRED):SW M i P ( 3#tT CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):51516 <br /> PRIMARY CONTACT: 0 OWNER IS CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 1A CONTACT PHONE: L. 2,c,�C,(�I b. ��-7 ata f <br /> N kA` Y Q4 Jacks&N CONTACT EMAIL:(ln tl Y1arV�tw�J�i ( rrir=lrh'lrj)etc„-�,,)j'I1 <br /> BUILDING PERMIT APPLICATION- t • <br /> _! <br /> Existing Use of Building: 1( ` � 4�-�&l�_ Contract Price of.Work:$ 4! ). 1 C) <br /> Proposed Use of Building: Q 4U-'ck l e.4Q.- Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: prSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project://❑New ddition (model CI Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WOR •. f <br /> ‘Q-A cam, c - .-.: --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 i,_Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #°{ List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump I Toilet Backflow Preventer(Inside Bldg) <br /> - Forced Air Systems Unit Heater 1 Bathtub Urinal <br /> Gas Piping Boller 1 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/SUPPRESSiON-SYSTEM <br /> Chemical or Water 1 No.of Heads , <br /> ACKNOWLEDGEMENT.'I have reviewed this application end 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 /> Bufdln. o "Dial be-face 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 comply with the State Contractors Law 1927 RCW and 296.200A WAC. <br /> Tp. City of Everett Official Use Only <br /> PERMIT f fl { \, 00.4©' I <br /> n y1► <br /> 1014 I <br /> 0 erlAuthorize Agent SI turn ate (Revised 9/23/2016) <br />