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• <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING /SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> 0427 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.govlpermits . <br /> (Rine or Rlack Inlc®nly.Please) . PROJE6T•SITE INFORMATION • • • . <br /> PROJECT SITE ADDRESS: etO5 yvMV\4O ISDN 6T- PROPERTY TAX#: 0 v 3q 30ocbo(cy <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> • ' .CONTACT INFORMATION • • {{)) <br /> OWNER NAME: nI4D?J /N�, Wthr TENANT NAME(If Commercial): M a.dc-S6-Kt /'ct.b <br /> OWNER MAILING ADDRESS: STREET I t pC, `jt)( ()...) W. <br /> CITY ,AtyU,*i,,tk j. ` STATE VIII ZIP Q e2 q/ <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: C kiCIR,GV9.-L 4U 6ria-TLr $EE k 46- -c. <br /> CONTRACTOR ADDRESS: STREET °�2 1 2...0 PSI At)lr <br /> CITY F=+()MUTT STATE (/t///��.flc- ZIP i s2Or <br /> CONTRACTOR PHONE: 4`z5 2.`"6(l4 • CONTRACTOR EMAIL: ,M 0:114i- a. ce,55 M(AA 1.45•4- <br /> CONTRACTOR <br /> C/MCONTRACTOR LICENSE#(REQUIRED): COG12.6,3S case)or CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): L o1 ef,5-5- <br /> PRIMARY CONTACT: 0 OWNER IZI.CONTRACTOR 0 OTHER(Please Specify) <br /> CONTANAM : CONTACT PHONE: 4 2 S--2S2`,//9 <br /> Al &Jv0 CONTACT EMAIL: 0✓) e ia>S/141.0A , OAA <br /> BUILDINfa PERMIT APPLICATION . - . <br /> Existing Use of Building: /' es-tukL/1 'f I Contract Price of Work:$ L1/6-06 <br /> --r <br /> Proposed Use of Building: f.1 o 01-4411/43 61' Heat Source: ®Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: El New DAddition CDRemodel ORepair CIT.'. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 12.04puer i/s (2467 rdi iw <br /> fz7" c'�P / Std ATV, c- f-x -M9-(.. <br /> 0 u e/rwl4 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL,PERMIT APPLICATION - PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn Alteration K Repair Type of Project: New Addn Alteration Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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 Refri• geration Shower Floor Drain <br /> Gas Fireplace 7 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 /> Number of Heads <br /> ACKNOWLEDGEMENT:l 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.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 Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> P <br /> O 2/(r( tPERMIT# <br /> 144,(5D -00. <br /> ,. <br /> Quaier/Authorize enf Signature Date (Revised 5/20/2016) <br />