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PERMIT APPLICATH- <br /> BUILI3IN''IIIIII o / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> y f 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 /> PROJECT SITE ADDRESS: 1930 6I/6 6RF"6\/ wAy (74j li(j PROPERTY TAX#:,Z8o4'/3dO3O 3C0 <br /> LEGAL for new construction: Short Plat/subdivision Lo o. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 61/6e.E71- )NVFXro/ S 2-4 e, TENANT NAME(If Commercial):2_Ak °s/Ag_►vi)tAv" i26GOVFi2) <br /> OWNER MAILING ADDRESS: STREET /c 0 2:7 S 6 <br /> CITYNe tn..)eAST`E STATE llA/,a ZIP 92oSq <br /> OWNER PHONE: OWNER EMAIL: f <br /> CONTRACTOR NAME: C,t.,14-3gie 7-spa J S/c I SE►ZV/CE <br /> CONTRACTOR ADDRESS: STREET S20 /22 a,� :c7- <br /> CITY <br /> cTCITY-7-A G'OX/VVA STATE ZIP q pii9.4 <br /> CONTRACTOR PHONE:2c,-3- 537- 7 7 S 2.. CONTRACTOR EMAIL: C 6)&(L )--r CO <br /> CONTRACTOR LICENSE#(REQUIRED):CvL?36 5S 2j.)6, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):V"S-36g 6 <br /> PRIMARY CONTACT: 0 OWNER ,�CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: G3k_07 S 2. <br /> 405 V ST6 4. CONTACT EMAIL: c 5S(><'Gg tin)TS @&4/ L v Co IAA, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 772 O <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ,)Commercial 0 Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ,PJSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: / TTA L.L. o /ArrazivALLy )44 A 4TE, BALL SlGAJ em/ <br /> Tgau4su T vvti41* (Sp,-,TN) TRJ OYz EzEVy4-n0 N <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 #of List of Fixtures List of Fixtures #of List of Fixtures #°f 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 /> 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 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.I am 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 /> PERMIT#�tc O »DO5 <br /> Owner/Authorized Agent Signature to (Revised 9/23/2016) <br />