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PERMIT APPLICATION <br /> '11141P/A4, ---A 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 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> due tBlack Ind .r PItl set - PROJECTZS.`I" 4 <br /> r� �M : tter, �- ,. _��� ` � .�� . <br /> PROJECT SITE ADDRESS: GSC) E)E2.Gi2.G£N W A` „S, i�ERTY TAX#: G O 3 t 3Q dQep MCC <br /> C <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER NAME: ,46-E /NV ESTIi4 7-S TENANT NAME(If Commercial):5 PEG!$L /NT: 4 i3 <br /> OWNER MAILING ADDRESS: STREET 6 9. <br /> 1 p de-t/tE) .lrti►t..t5—Eh.J WA W <br /> CITY 0'(/E12 C'-'77 STATE A.,44 ZIP Trz.0 <br /> OWNER PHONE: 442 S - 35 3- "2-3 iS''( (OWNER EMAIL: '$ I Q Yi t Al OQ . . c+ <br /> CONTRACTOR NAME: lQ-d, r f4 act. 17 d• (2 L9 C_'r— V C_ S f' N L <br /> CONTRACTOR ADDRESS: STREET j ( �Q I a 7-#-> 41, - <br /> CITz5 I <br /> Y ,�j E' 4 7 7 L..L`: STATE ‘4.1.0.51- ZIP 9 fc/0 c• <br /> CONTRACTOR PHONE: 2.0 6 7 Z 6 ©4 4.b (CONTRACTOR EMAIL: &ICAHAR0@ f2T I4 OD.Go 1'x'1 <br /> CONTRACTOR LICENSE#(REQUIRED): IZTHdel)' C C 3' L._ !CITY OF EVERETT BUSINESS LICENSE*REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER jeCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: c CONTACT PHONE: 7._c)6 S(C) eDtg-3 4,4 <br /> �._ l i-{4}isr J(M, 1 7'/..4 CONTACT EMAIL: 1214./-1.4m (- 2.77iG00.CObtl <br /> : ' f, BtUIILD G -trgO T PPLICATI k`i k Z ,,, <br /> Existing Use of Building: Contract Price of Work:$5 Q.OG,O A o <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: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ®Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: N 5 7.-4, Fet2,E s t.,0 p Re. Ss O& 6'Y5_ 5 hi /N <br /> 19, <br /> r4 I N r- IQ d0Q7"0., II�X, /NG-- /2.[0`01''% <br /> ASSOCIATED BUILDING PERMIT#(if applicable): Jt.L002.." lJ t <br /> 1V ECH ICAl,� ERMITA ';UCATIQ!1, . . „ .. . PLUMB( G ERMIT AP ATI 1 <br /> Type of Project: _New_ Addn Alteration _Repair Type of Project: _New Addn Alteration _Repair <br /> #of List of Fixtures # List of Fixtures of #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C <br /> –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-I'SUPPRE SYS '^' <br /> K Number of e s g <br /> ACKNOWLEDGEMENT:I have reviewe this applica' 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 g 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.lam 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 /> PER <br /> isVA _ cz-«- i6 IT CLQ 2_ — 00 Co <br /> Owner/Authorize Agent Signature Date (Revised 9/23/2016) <br />