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PERMIT APPLICATION <br /> #1111"::4 <br /> 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 www.everettwa.gov/permits <br /> (Blue qr Black;Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1'0 7....1 Ver q „, '4"-y PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision 6J Lot No. _ (attach copy of long legal description) <br /> ..CONTACT INFORMATION. <br /> OWNER NAME: MLS}t4 f-L CA.3iZe,E TENANT NAME(If Commercial): C EOKC,E. 012:14-10bOt T ICS <br /> OWNER MAILING ADDRESS: STREET 1i3flq A �_ <br /> CITY V'✓`-.© v�k.7-v•-"--,:• ' r‘ STATE ',J\ ZIP . 9 ti,�o <br /> OWNER PHONE: 42-6 -330-c5 05 . OWNER EMAIL: - _"i <br /> CONTRACTOR NAME: <, E.Ti C_rZ 1PL.L.VVVI is i.Ni et <br /> CONTRACTOR ADDRESS: STREET t 5P0 11 WE sT'N/-i C-�1< Ro (f� 8'2_,c0 <br /> CITY 5•N014 Oyu 1' (-1 STATE �/V ("t- ZIP q <br /> CONTRACTOR PHONE: 3GO-5(:)%-�, -/.1"1 CONTRACTOR EMAIL: `3.e.......0_ b-e-1 p* <br /> CONTRACTOR LICENSE#(REQUIRED): SETL P* 1,0 c, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: p CONTACT PHONE: 1-124_15 - 1 6 1 1- <br /> M 1 �A N S TZt.K. CONTACT EMAIL: ,t; +C.c (Z,s-e.,+Z.e r-tr�1 u -t,b1p✓1 c7®Cti=`'Yv) <br /> „ . ;:', ,. .,. - BUILDING PERMIT APPLICATION, <br /> F' <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition El Remodel CI Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): • <br /> MECHANICAL.PERMIT APPLICATION 'PLUMBINGPERMIT APCATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn Alteration _Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> A/C—Air Handling Units Heat Pump if Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air.Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler t Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove L. 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 Heatsr 3 Other: ' ',M. 'M, S$-o,.-1.>°o,r\ <br /> Exhaust'fan : —Sink(Service/Bar/Mop/etc.) Other: <br /> �Kn <br /> - SPRINKLER I SUPPRESSION:SYSTEM;;; <br /> Chemical or Water I No.of Heads <br /> ACKNOWLEDGEMENT:/have reviewed this ap.'cation 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 grantin. •• •permit only author zes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under a cumstance.l 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 co r• e State Contractor a 1181 'CW and 296.200A WAC. <br /> / Ea <br /> Al <br /> City of Everett Official Use Only <br /> PERMIT# <br /> i Iv.1'1. sir r►��' 7 rc-10'7-015 <br /> Owner/Authorized Agent ignature Date (Revised 9/23/2016) <br />