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PERMIT APPLICATION <br /> °#10‘%/L11"."--A‘ BUILDING/MECHANICAL/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 rwwuv.everettwa.gov/permits <br /> (Blue or Black Ink Only Please)„ PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ?S 11 5.e sVf.,r 4- Nkau /,,,Lti 5)--t_1\ PROPERTY TAX#:2$(51 806 3071400 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:12A0 V1 ).C(oprvtavt 'f Pte, Myrht 4ENANT NAME(If Commercial): 5pv:.‘,tr\-j- <br /> OWNER MAILING ADDRESS: STREET (0 2. 4 25 2,r d P) A)S <br /> CITY d STATE w pc ZIP13 <br /> cO5,3 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: R10 f1-e( � A, CCxv\l)uf\A.1 <br /> CONTRACTOR ADDRESS: STREET 2-U' OA \-\1 jj\ji CI Gt <br /> CITY NA.O uA 01- V &(Y\ '\ STATE Of Pc ZIP <br /> CONTRACTOR PHONE: lP p -1'12-II 13 a.5 CONTRACTOR EMAIL:S-c e-(et ,\ GQ me utecS ,(try. <br /> CONTRACTOR LICENSE#(REQUIRED): �J' \4 F���r 3'?)23z- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 3(D <br /> PRIMARY CONTACT: 0 OWNER ErCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 3Le0 -4 2,14 .-( 3 9-5 <br /> f\400,(19-S CONTACT EMAIL: <br /> � Ske4ar�teC�M14:{"i er,5iclo-CA" <br /> BUILDING PERMIT APPLICATION = <br /> Existing Use of Building: (9 4f t j Contract Price of Work:$ Z 13 Das() 0 <br /> Proposed Use of Building: rt, Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial El Industrial <br /> Type of Project: ONew DAddition ❑Remodel ❑Repair ❑T.I. lEtt ign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1 W` N-r Z c\-e A) r ` ��} -( LA) ' Gt y\S <br /> (WA) - 01\ p u g f-a C.&- or\ ex.i 5 "y Free 1 r%rV1 %� q sj yam. <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 #°f 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 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, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> Z1 74 , 7 PERMIT# ' 12: W <br /> Owner/Authorized Agen Signature • Date • (Revised 9/23/2016) • <br />