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PERMIT APPLICATION <br /> '111P4" <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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> r <br /> PROJECT SITE ADDRESS: :5 5O Uro Le% Ai V PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> /.'6 C ONTACT INFORMATION <br /> OWNER NAME: pave,e') +1•64&# ( )1 yv,s jIfl4yki ENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 35, J�i7 0Ali s a ti� ,L �g�i / <br /> CITY 5 V`9te t �S�TA,TE/ A, //Op ZIP �/V o / <br /> OWNER PHONE: laI t pg If�' 0 I 4 OWNER EMAIL:{ CJ�j( n't-eod,CS,41*deIse yki e fC yAI`iDG/rz0 <br /> CONTRACTOR NAME: Of <br /> //'//VA l,k; exo /,//Bili,,, rj <br /> CONTRACTOR ADDRESS: STREET )5 gv pa owe- , <br /> CITY6 y STATE It ZIP si//J i(/ <br /> CONTRACTOR PHONE: 7!3 p, 1",/ 7�. CONTRACTOR EMAIL: Q °i�PPQ/45j(t( ice/aka,-eh/(e/ak 't <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: I"OWNER 0 CONTRACTOR 0 OTHER(Please Specify) �//� <br /> CONTACT NAME: 5 evil- 5 /4,4 <br /> IC,( CONTACT PHONE: (,��S d I-�11Q J ��� q /� <br /> �' CONTACT EMAIL: ��/ �X e),...e /i7fr hzeA'f )/: �9 <br /> BUILDING PERMIT APPLICATION i' <br /> Existing Use of Building: /1-W1' / h-- Contract Price of Work:$ ��3 <br /> Proposed Use off�Building:,ui/ 1]H41,4 eat Source: ❑Gas ❑Electric ❑Other <br /> Ll�'S <br /> Building Type: FR-Detached ❑SFR-Attached Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Additionemodel f Repair [M. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: OpeK <br /> thifrkfa f tO pj 4,661 .014 ka2‘5.' . vi .'frIet_f• <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 /> 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/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 I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the St-�;Contractors Law 18.27 RCW and 296.200A WAC. <br /> / PERM/ / City of Everett Official Use Only <br /> P / / ff - a//• 6 `� c O - ©s o <br /> Owne Authorized Agent Signature Date (Revised 9/23/2016) <br />