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PERMIT APPLICATI04- <br /> 000,,:-- <br /> BUILDING/MECHANICAL/PLUMBING I SIGN /SPRINKLER/DEMOLITION <br /> f CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 ((E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION, <br /> PROJECT SITE ADDRESS: "2 2 1 ( Y1'. PROPERTY TAX#:OO(P1 45 ocher izwipd <br /> LEGAL for new construction: Short Plat/subdivision V4) lr("Ti) '.t`7 Lot No.i (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: \/(IJc 1 " r1AM '1'110jAr- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET -2_17.-4y,�O�7 14' `j"r <br /> cm, e ` STATE 1./..346- ZIP 1 <br /> OWNER PHONE: 1..-0C9 j 5-.4f s ("Q„ic? OWNER EMAIL:cj©12I-0 r r, MQ(/ Cc3h CCC✓✓/ <br /> CONTRACTOR NAME: 1 ON( PA(NI <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): T TION C at CITY OF EVERETT BUSINESS UCENSE#(REQUIR : ^ 1 <br /> PRIMARY CONTACT: El OWNER 0 CONTRACTOR ,QTHER(Please Specify)_ tZ. t;77RC( j "'(' <br /> CONTACT NAME: CONTACT PHONE: D—192_-G1;et.$Z <br /> CONTACT EMAIL: . tki18 , <br /> P� <br /> BUILDING PERMIT APPLICATION nn <br /> Existing Use of Building: CLI -- � — Contract Price of Work:$ /01 ,31 le. 0,-- <br /> Proposed <br /> 'Proposed Use of Building: / OOC,f' Mt(L.)-I, ji,I* Heat Source: 15Ias ❑Electric ❑Other <br /> Building Type: SFR-Detached OSFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition Oemodel ❑Repair ❑T.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: c; w_It wo, 4.C_C Lo <br /> G k1 a 3 1-zz, Q�•pU�-r' 'T �^'ti t Vk <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn Aidteration _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 /> I Water Heater Refrigeration I 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: I Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> 7.. Exhaust Fan 1 Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> 'Chemical or Water ' '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.lam the owner,or lam 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 /> PERMIT (---10 D <br /> ` 05 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016)/ <br />