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PERMIT APPLICATION <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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: -7 Li 0 7 F P,cgfeer, (A tui PROPERTY TAX#: 00 a q3700/0e)-3o4 <br /> LEGAL for new construction_ Short Plat/subdivision Lot Na (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: yy a-"(s Luc TENANT NAME(If Commercial): 'FC„ <br /> OWNER MAILING ADDRESS: srasEr i 1p <br /> a` 3)Z s/7 an d I/)e,(,v 0 c. 6V I..0 , <br /> err( Sl"C{V11iUDOS STATE V(r— 7P 939—/Z <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: M.pa/-e/ sl-lit 4-- U <br /> - fk� ex-14-51 n ri <br /> CONTRACTOR ADDRESS: `�`l smEET 7Jj e)ii CriGj <br /> CITY MO Lt. Vo\ STATE Wk. z, q 273 <br /> CONTRACTOR PHONE: �j/,Q 0~ � --! Lc CONTRACTOR EMAIL: Stec-ad;t( ' e,(-5`i e h , L/,,n1 <br /> CONTRACTOR UCENSE#(REQUI RED):Lis sv.,5 o�'g-as CITY OF EVERETT BUSIPESS UCENSE#(REQURED): Z O a-c(, <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAM: CONTACT PHONE: 3(ev- ii f' 1328- <br /> ‘S -AMa i t tit N d zid-t 5 l1. CONTACT EMAIL:S .e.. iri-t L @ 0,L,:�7„✓si rli ' . con,.‘ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 1 i 000.'00 <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 ['Remodel ❑Repair ❑T.I. 43rSign ❑Sprinkler ❑Demolition ['Change of Use <br /> DESCRIPTION OF WORK: k,..cu.w e) (s ,.11 ?'Ion �� /p G 0 i' /LPL Vela()a1,, 1 <br /> I ��"(au_ � SGL <br /> }ei " c- C—tt,u, tVG mAtm Crux, A- C---t cLeg. i $ div tai ofN aA S\lwk,s <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 List of List of Rxtrxres <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC–Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub . Urinal <br /> Gas Piping Boller 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/SUPPRESSION SYSTEM <br /> Chemical or Water I INo.of Heads <br /> ACKNOWLEDGEMENT!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 therefromm.Deviations must first be authorized in writing from the <br /> Building Ofaal before being authorized under any circumstance_tam the owner,ort am authorized bythe owner of this property to perform the work for which application is made, <br /> and t comply with the State Contractors Law 18.27 RCW and 296.200A WAG <br /> City of Everett Official Use Only <br /> n 1 PERT\ CS <(), <br /> l <br /> `. , f !�: "9 , , t l ( � (Revised\9v/23/20166)) , � <br /> ( <br />