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PERMIT APPLICATION— <br /> BUILDING <br /> PPLICATIONBUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/'111P/OtilACITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everette.s•everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE IN + .;MA "ON <br /> PROJECT SITE ADDRESS: g OCA .Euertk.sr 'VN11,\ UtJ' c)i_tPROPERTY TAX#: 7i--7`(o,j <br /> LEGAL for new construction: Short Plat/subdivision L. No. (attach copy of long legal description) <br /> CONTACT INFORMATION Kik- -t (.. Ai ,,-,.--c., <br /> OWNER NAME: 7 C.rc 1�Ybe.2., TENANT NAME(If Commercial): "T`� AkAy P1,w,,�,‘ <br /> OWNER MAILING ADDRESS: STREETI�7 t7\O 1C" AVE N c k.5‘..\-e...„... Cy , <br /> CITY IL,t`(_e jve. STATE WA ZIP 9 b00 <br /> OWNER PHONE: 4E1 — Li' ..G""— (I ;--10 OW ER EMAIL:` et-v,r;,C, Q 4Vh&GCS • com <br /> CONTRACTOR NAME: S Hq,( Spn ( kv\- or La(p <br /> 9341AsCe....) <br /> CONTRACTOR ADDRESS: v 4'f <br /> STREET <br /> i(i 8(t Gp+t'\ <br /> /� �,, <br /> CITY LA Gey STATE A. ZIP g erI- <br /> CONTRACTOR PHONE: ( 7 — 14-41(o^^— Lt02.0 CONTRACTOR EMAIL: ' W\ v\2 1(o e r+ <br /> CONTRACTOR LICENSE (REQUIRED): C 0)9,6 O k0� 0 CITY OF EVERETT BUSINESS LICENSE#(REQ RED) Edi <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) �'i�0---- l r <br /> Ili <br /> NAME: CONTACT PHONE: "LQto— Q s2__-�1L fTQ <br /> Av\dc€tAD WN CONTACT EMAIL: AA6c -.•0, . -22 ,,,,,A , ( ,coo, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of ,,rk:$ t i S9®. 00 <br /> Proposed Use of Building: 'kPc o_}fOti/t,k- Heat Source: C-s ❑Electric • er <br /> Building Type: ❑SFR-Detached OSF5Attached ❑Duplex ❑Multi-Family-#of Units: n ommercial El Industrial <br /> Type of Project: ❑New ❑Addition [JRemodel E3 Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> k .D6M0 LOAN --(-or v &PC. <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 #°f List of Fixtures #of List of Fixtures #°f 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 I 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 authorize.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 mply with tie State Contr. .rt Law 18.27 RCW and 296.200A WAC. <br /> PE loT# City of Everett Official Use Only <br /> \� <br /> -- --1..�ilr A. —tet ,�_ Oc - 02 <br /> Owner/Authorized Agent Si nature Date (Revised 9/23/2016) <br />