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PERMIT APPLICATION <br /> 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> e or B : Mak On'y Please? . «_. , �_ i QTR ! MA 114VNM a , y P gill l rz l <br /> PROJECT SITE ADDRESS: '2-1'SV lam.-til l be- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> > "'' A �CONtACTINFORMATION'; <br /> OWNER NAME: J SsL . S L fpr)& S 2 • TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2...97C)..`}'{ L. Lu,-, 'b e._ <br /> CITY .Z, Q/" STATE ZIP 9 <br /> OWNER PHONE: 9-bLp° 4 tot • S- OWNER EMAIL: <br /> CONTRACTOR NAME: t OV v�� Z >�Gl 11 t Ja LI,lh O & <br /> CONTRACTOR ADDRESS: STREET `ro '�fJ� -7 <br /> CITY iki[cLe-19/L�f�, STATE N A.- ZIP (p 2s1-6 <br /> CONTRACTOR PHONE: 5LQ0'tQ ' 1 0 CONTRACTOR EMAIL: 1(} � 1 <br /> `� UY1 he_ichn conc.) <br /> CONTRACTOR LICENSE#(REQUIRED): .9 T i .- 1++1s gt&ofi CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O OS <br /> PRIMARY CONTACT: 0 OWNER i l CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT <br /> NAME: CONTACT PHONE: Seo Le • c660 <br /> JUpAtet <br /> CONTACT EMAIL: hta(--h 0.o , 1cv-r <br /> BUM; I1101 t PPL..ICi ,' 'IO t, <br /> Existing Use of Building: Contract Price of Work:$ 12-OO <br /> Proposed Use of Building: Heat Source: 4Gas ❑Electric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial CI Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WOR�i cu loll l ' <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 /> NC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> I 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 /> B,ai(ding 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 /> /dl nd I Imo with th tate Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> lb figfrtigtO -031 <br /> Ow er/' • orizid Agent Signature Dat (Revised <br /> 9 9 9/23/2016) <br />