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PERMIT APPLICATIOMpik <br /> 101174„,/— BUILDING/MECHANICAL/PLUMBING/SIGNINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> s� 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX,425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue ouBlack Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: „'.I.' 4,14-5 ©r• Eviler PROPERTY TAX#: — <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> Arr . ';CONTACT:INF'ORMAT(01!I':,= <br /> OWNER NAME: EST irk_ NOt'Th�f + TENANT NAME(If Commercial): --- <br /> OWNER MAILING ADDRESS: STREET %'Ll <br /> igoa ra® pt. SE <br /> 1 r� CITY 6v fiat_ STATE ZIP {gag <br /> OWNER PHONE: Jigs • 3 eL' 44 OWNER EMAIL: thIli{hG.lyt(D.b i ki'No•0r_ <br /> CONTRACTOR NAME, A-M to t c5e &)CC wilt YW <br /> CONTRACTOR ADDRESS: STREET Po heti, <br /> CITY 51411 w DO4 STATE"titJ/►� ZIP g8 7A <br /> CONTRACTOR PHONE: '425'2/8 • )17() CONTRACTOR EMAIL: N W A.°eOL15tro MA I , corn <br /> CONTRACTOR LICENSE#(REQUIRED): No�t�}NC..gbb CITY OF EVERETT BUSINESS LICENSE (REQUIRED): g ,1(o <br /> PRIMARY CONTACT: KOWNER 0 CONTRACTOR 0 OTHER(Please Specify) y� p <br /> CONTACT NAME: �© CONTACT PHONE: Apt, "l`�� .• 3a2 l <br /> kW CONTACT EMAIL: `4h1'D I6 "Iv.het YYtt16 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached El Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ['Sprinkler glDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: I I �" <br /> con kkG DioV� a•c Vmk4-e. <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 #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/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 lam 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 /> r City of Everett <br /> Official Use Only <br /> l• PERMIThb ot)1 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />