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Ork-17- PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /� INKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: q p(ni / (JC yV e,,,2 PROPERTY TAX#: OA'1100/10:9519/ <br /> LEGAL for new construction: Short Plat/subdivision "7q0Ze 1022 l Lot No. /4 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: CiRaycire/d( P,rJ(�er�iYS L,LG TENANT NAME(Iff Commercial): <br /> OWNER MAILING ADDRESS: STREET 66 1724 \J Mar if., V re,,) 6,r, ✓T.e- 11-1O n <br /> ,. crrY ,tPrel l STATE �r� ZIP CO-201 <br /> OWNER PHONE: p125 }{-.7 0 %976 OWNER EMAIL: a►^eaves Ci 6:10 eylj v5, " <br /> CONTRACTOR NAME: FI ile/ 4417m421 <br /> CONTRACTOR ADDRESS: STREET p,o, extgV I Z <br /> CITY Vi it tt,.vi STATE VI-- ZIP ?eV-7Z <br /> CONTRACTOR PHONE: .Z9,6 r7/9 1 7'1 7 CONTRACTOR EMAIL: - Jlpa"1y,i{f{,t/ht lfb e...0,1I1hi „ /.."-- <br /> CONTRACTOR LICENSE#(REQUIRED) F1Gi,•k,J IALSP62P14 CITY OF EVERETT BUSINESS LICENSE#(REQUIR-s)-EgZ/b J <br /> PRIMARY CONTACT: ,OWNER 0 CONTRACTOR 0 OTHER(Please Specify) rt ,k A ►, r <br /> CON CT NAME: [��,,�� CONTACT PHONE: �25 l f 7 R l „.� <br /> .V,W 11XF1 Y. CONTACT EMAIL: o yeiNie-- r-1UPM6JNu.Y'3,.C.(9Ii'1 <br /> BUILDING PERMIT APPLICATION '/ <br /> Existing Use of Building: /ava f� Contract Price of Work:$ ii2c2 t .(,,,p� <br /> Proposed Use of Building: / Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: El New DAddition El Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler Demolition El Change of Use <br /> DESCRIPTION OF WORK: <br /> De/W19[161/1e2(164 612M ( tJb(d <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 #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C–Air Handling Units Heat Pump Toilet Backflow Prevente e Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) ' Ing Fountain - <br /> Water Heater Re ' eration Shower Floor Drain <br /> Gas Fireplace ood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Wash Medical Gas <br /> Range Hood Water He r Other: <br /> Exhaust Fan Sink( ervice/Bar/Mop/etc.) Other: <br /> SPRIN R/SUPPRESSION SYSTEM <br /> Chemica or Water I No.of Heads • <br /> ACKNOW EDGEM- T: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 :.-ral,st- <� •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 .9 icial b-!I .eing 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 c rp.ly wit "� ate Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 1 . <br /> ‘/76PER 11;* lgoL — 0X5 <br /> OwneriV Agent Signature to (Revised 9/23/2016) <br />