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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 477-. 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> 42. PROJECT SITE ADDRESS: 0430 ` Lll QTT W A% f�f QQ 1 ,„_3 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:gudi 09 s TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREETS(2430 f LUoU IJ 19 � ) Q <br /> (' 1 ��/� CITY IDIM ` • STATE WA ZIP a$ ow 3 µy <br /> OWNER PHONE:4�J"q'f�l' -1' OWNER EMAIL: 0 0,- <br /> kr <br /> `,� /'SiCONTRACTOR NAME: S'� AfIA) � S Il. "�► S470( y`''� <br /> CONTRACTOR ADDRESS: STREET MAO, o3 J 14 132'"D fry e lV E <br /> CITY y(0 Ola ViLi E STATrE,,yIT' ZIP /ff 0. -- . <br /> CONTRACTOR PHONE:((c) 36-1 -No 3 CONTRACTOR.EMAIL:bill cw)cto V s o. proo c • M IL <br /> CONTRACTOR LICENSE#(REQUIRED` S1ARr R*S(07)-- CITY,OF EVERETT BUSINESS LICENSE#(REQUIR a" / i. .v <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR Ei OTHER(Please Specify) Of-Fire SS(STAn)l <br /> CONTACT NAME: <br /> ��(� CONTACT PHONE: (4ic), 'aca-A- 3 3 91 <br /> (fit-IRNA "'"" CONTACT EMAIL: ij(+t G.vYjq.(y1�.Uf p tOOa (1/11 ^ G,0'44 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$4- 9(WO <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> learecriE sh I pyua.S 1 rer facr-ct4-"et , 1�15,(ui.ea- ((A wocct ctva. <br /> 4o -C--I OF Ccascl a.. <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 /> 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/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 bet, 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, <br /> and I comply with th; tate Contr-etors Law 18.27 RCW and 296.200A WAC. <br /> i r/ City of Everett Official Use Only <br /> 00/ V \0."—' °C3 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />