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PERMIT APPLICATION■ <br /> tliP/111°:-. —A 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 1 www.everettwa.gov/permits <br /> (Blue or Bl11:4it1.1IC tOnly.Pleas®j; , PROJECT SITE tFONMATION , <br /> PROJECT SITE ADDRESS: i bl'?:1 Jerc,,,,44„ (,0t,,/ I 0 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision C' Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Vac, Ply ,4s5elCA 0i SOr c TENANT NAME(If Commercial): ‘--yr-C), 1/10C4, <br /> OWNER MAILING ADDRESS: STREET (D( C S C3t,' Si. ) S(A;k �/,I c <br /> cry I Ie�tLL STATE CA.-)0- ZIP C.3 00() <br /> OWNER PHONE:`1 . - 9 90 (9)CO OWNER EMAIL: 5-1- <br /> V191/Ia v1Ike (J 1)Ok-fid U 1 SC 5,c ov, <br /> 9 <br /> CONTRACTOR NAME: e,e:::,* v Sl robe-e <br /> CONTRACTOR ADDRESS: STREET I�), 'D 604411 50-el p/ fi{/.y j� <br /> CC„ � ,pT`\ Cv *— STATE( )/ ZIP t G loia <br /> CONTRACTOR PHONE:ya'c -330 $I(06 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): u.TSJS 6. pa CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):c..-S/04 <br /> ,. ,. .._v..., ,....._, ... .,... .. _y.. _ .. ..,. , . , . �,._4_� .0 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR OTHER(Please Specify) 5k,V O 1-..C{ <br /> CONTACT NfflAE: CONTACT PHONE: 4.-1 ?C 3._ 417 <br /> 1 LeiViikl .. Qrt- CONTACT EMAIL: € 803J112A),.,/ , n C_a� <br /> .. , , BUILDING PERMIT A'PPUCATI N. , <br /> Existing Use of Building: Contract Price of Work:$ 2c 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: ❑New ❑Addition ❑Remodel ❑Repair CIT.!. FiSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: I f neA4 G r L 0 C\Ac J I <br /> Ji „ ,F, (, <br /> a Lo 70 gc><-6 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICALPERtM,IT APPLUCATION,r ,. , ` PLUMBINta ,P IT APPLICATION ` ., . <br /> Type of Project: New _ Addn Alteration _Repair Type of Project: _New Addn _Alteration _Repair <br /> #of List of Fixtures #°f List of Fixtures #°f List of Fixtures #of List of Fixtures <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 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 F-SUPPRESSION.SYSIfEM <br /> !Chemical or Water I INo.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 onty 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 aw 18.27 RCW and 298.200A WAC. <br /> City of Everett Official Us[(h _ oe Only <br /> �"" ) K. <br /> PERMIT#8 !1f)„,... <br /> Owner/Aut d Agent nature Date (Revised 9/23/2018) <br />