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PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> 4 ,f.44W? <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 /> tBlue' r Black Irak Only Please;} PROJECT SITE I1 FORMATION . <br /> PROJECT SITE ADDRESS: /0 2/0 Eve-rqJ ree>7 (Amy, �ticy r�-, buil• PROPERTY TAX#: =2 (p5/(o.23 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ll CONTACT,INI ORMATI ON <br /> OWNER NAME:' 2. C.)eke r,rl AjaV'Ic \or J..n,n .f Su").TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET3ScY 18B411 ,..Sk. <br /> . SI.) GA-e /,2) <br /> CITY (...la Yln(,3ht7 STATE WA ZIP 9e03"j <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 'St a.rt ""7..o p�4 1,-1 £ S( c�)'713 <br /> CONTRACTOR ADDRESS: STRCgT L/Z 0 'Peri 5f R,a- J <br /> CIN 12)j \;C19 x5Y1 STATE I I)14 ZIP 7 �3 3 <br /> 2 <br /> CONTRACTOR PHONE: oD-'(5j-i_ '7.. <br /> ocj 3 , CONTRACTOR EMAIL: ''y1,�@ E n Yq , Cow) <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT VERETT BUSINESS LICEN #(REQUIRED): 0L54 9 <br /> PRIMARY CONTACT: 0 OWNER OCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 'Q), t .. CONTACT PHONE: 3( 0----i 5--/- 0933 <br /> CONTACT EMAIL: `bre &EsG r[A,C.er I <br /> . ' ; BtIILIDI,NG PERMfT`APPLICATIGIN <br /> Existing Use of Building: V-NkoVC\ Contract Price of Work:$ 1.13 $$,`� <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: CI SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ig€ommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition El Remodel CI Repair DTA. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 'R oVG 2.Ki.skin j rboc ' avtc. 1 �� <br /> .il E, tO4'r Sin�elc1 aaC� cart4irkt <br /> C io nn,er,`->rb'cY) J Ty <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 #°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;t 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.I am the owner,or 1 aln 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 /> n /l- n // g^ 27' / PERMIT# fO3/Sm <br /> Oip <br /> er/Auutthhooriized Agent ignature Date (Revised 9/23/2016)V)"-) Il.r4CC: <br /> (\ <br />