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PERMIT APPLICATIOt <br /> i°1111.10.b/Abr'--"A BUILDIN(MECHANICAL/ PLUMBING /SIGN - tINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue-or,Black Ink Only Please) PROJECT SITE INFORMATION <br /> u <br /> PROJECT SITE ADDRESS: �� ..tier ,- v1 g14,g'0 ,,cet GSA �8Z'3 PROPERTY TAX#: 190_3/3 Dnp )200 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: A(-E i„ejd-,y,ick TENANT NAME(If Commercial): S ,til h -AA6gcrd <br /> OWNER MAILING ADDRESS: STREET llol Atik: 6 Sail-6 201 <br /> CITY Swallosiisil STATE fN„4. ZIP 1)2(11/ <br /> OWNER PHONE: 36(x-142-/coo OWNER EMAIL: Ko c 1s �,n/ A�'ps 6,or , owe <br /> CONTRACTOR NAME: -5,nm„nT ' CCII C <br /> CONTRACTOR ADDRESS: STREET 61'10 Lety'eat4 Otc, <br /> CITY rve fe4 STATE PA ZIP -(r 3 <br /> CONTRACTOR PHONE: 1.123--35-3-2381 CONTRACTOR EMAIL: S iAh i nt LA et10o. x,00. <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR gOTHER(Please Specify)�,u,1T <br /> CONTACT NAME: CONTACT PHONE: L/25--3g-3-23 y-i <br /> _.CLT51.- d s <br /> II CONTACT EMAIL: ,tib��Lt „vv.” <br /> cJ BUILDING PERMIT APPLICATION . ` `` <br /> Existing Use of Building: / 51 Contract Price of Work:$ 4 2 �i <br /> Proposed Use of Building: 4,,,e-9 13„10 St Heat Source: W'Cas ❑Electric DOther <br /> Building Type: ❑SFR-Detached LJSFRR--Attached ❑Duplex ❑Multi-Family-#of Units: ji[Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair J.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use ___ <br /> DESCRIPTION OF WORK:y 37L A AL PPA- &off, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATIO PLUMBING PERMIT APPLICATION, <br /> Type of Project: New _ Addn Alteration _R pa 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 /> I _Forced Air Systems I 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 if Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> (VA- Range Hood Water Heater Other: <br /> a Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> ;SPRINKLER/;SUPPRESSION SYS M " I" , <br /> 14 INunnber of Heads A i <br /> ACKNOWLEDGEMENT:I have reviewed this application and itfm h- 'ormation 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 Y/J_ <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� wpich application is m r <br /> and I compl.wit t e State Contractors Law 18.27 RCW and 296.200A WAC. /GY! 1 - ( 110O4o-6 Z$ -� <br /> City of Everett Official Use Only <br /> 03 /6 PERMIT# <br /> r� `ji *07-�r D tl <br /> 0/ er Authorized Agent Signature Date (Revised 5/20/2016,' <br />