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PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING/SIGN/SPRINKLER I DEMOLITION <br /> CiTY OF EVERE i I PERMIT SERVICES <br /> .4itig 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 1(E)everetteps o@7everettwa.gov I www.everettwa_govlpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: :42, 1t+ Ail, F/?A,t j„, f L'ff gv2e i PROPERTY TAX#: <br /> LEGAL for new construction: Short Platisubdivision ,...--- Lot Nor,.'' (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: HY 1 nvefiT mevtj- L.',l't'ti 'c':r9� (RT TENANT NAME(If Commerciial):”j)r L.,_ V1tT:7.LI✓c. <br /> OWNER MAILING ADDRESS: siREET yt340<� r3 - 1" it iP7 �% �7/! <br /> 1 <br /> Gil ta t}. i I t ^�. STATE toil i ziP q 23 6 <br /> OWNER PHONE: ',1 (,7— � e G 111` OWNER EMAiL: i.u, " 0-,t.._ a I iiiffJ� <br /> ")f 1'4�- �` C� Lit'i if) t q i,(40 1.ex.•t, <br /> CONTRACTOR NAME: GLOure TitiktAA0 4\f\$,- <br /> . <br /> CONTRACTOR ADDRESS: STREET 0.0-3E)iii A,,,,[ . <br /> CITY Ps.6 .v!t \ k."t V v—.. STATE J y u ZIP 1 V a-7 3. <br /> CONTRACTOR PHONE: () S61-k S6 �J CONTRACTOR EMAIL: Sk sill€pti,tvi�14Alf( ,M,....( . . (t7 vv-- <br /> CONTRACTOR LICENSE#(REQUIRED): j'(C cC11Vic 3 D6 CITY OF EVERETi SINESS LICENSE#(RE IRED): pew I ' <br /> PRIMARY CONTACT: 2 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) tLt <br /> CONTACT NAME: `CONTACT PHONE: 4C,, --"7" t1.- 7/4$yC}, <br /> t <br /> `‘Aci f (&` C�t J ,„yve t/-S CONTACT EMAIL: i v‘ tr"l 55 i-L 11.ktiA h = <br /> ,co-}-, <br /> BUILDING PERMIT.APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 16.t c ci <br /> Proposed Use of Building: Heat Source: OGas ❑Electric ❑Other^ <br /> Building Type: ❑SFR-Detached ©SFR-Attached ODuplex DMuiti-Family-#of Units:, ECommercial ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair 6tl/f.L OSign OSprinkler ODemolition OChange of Use <br /> DESCRIPT�f N OF WORK: <br /> / `a/mk/`'- f 7:/. <br /> ASSOCIATED BUILDING PERMIT#(if applicable):•El 7 jt —ealt j M Alvi!''j r(1,1--t O <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _,._Alteration _Repair Type of Project: _New Addn Iteration Repair <br /> #ofList of Fixtures #of List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump 0 Toilet 0 Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 0 Bathtub 1 Urinal <br /> Gas Piping Boiler 6 Lavatory(Wash Basin) v Drinking Fountain <br /> Water Heater Refrigeration O Shower 0 Floor Drain <br /> Gas Fireplace Wood Stove 0 Kitchen Sink&Disposal 0 Grease Trap <br /> Gas Range Ducting ) Dishwasher 0 Roof Drains <br /> Clothes Dryer Hookups Other: - 0 Clothes Washer 0 Medical Gas <br /> Range Hood () Water Heater Other: <br /> Exhaust Fan te Sink(Service/Bar/Mop/etc.) Other. <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water ` 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,stale,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.t am the owner,ort am authorized by the owner of this property to perform the work for which application is made, <br /> and i comply with the rte Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> �. n'/� ,0 , izedyr'tS •na e / ate (Revised <br /> 9/23/2016) <br />