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4677. <br /> PERMITAPPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING I SIGN / SPRINKLER / DEMOLITION <br /> CII Y OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET.EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps overottwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3063 J. CA-r"No V rJ Eutirleki q 40 A AV 2o3 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No._____ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Capt►tet , TENANT NAME(If Commercial): i3oetdti <br /> OWNER MAILING ADDRESS: STREET '73(503 t,J. :ze,5 ina iu-+ (et t4itl 40» 0 S CITY EvevG p STATE OA ZIP -, '} Zo <br /> 3 <br /> OWNER PHONE: qts -304.. t01t. OWNER EMAIL: 1owi lx,rt.1, {„ . (Vt& r* .. .cower <br /> CONTRACTOR NAME: C ►1i ftr$i- MCtin4wICa.I dro Af e'fDa,St kc. <br /> CONTRACTOR ADDRESS: STREET Ilion 4 41, pkcc,, of,,.c- <br /> cn v tAut,k;t t'I'to STATE iota ZIP 0012.15 <br /> CONTRACTOR PHONE: 2.53 M(01O• 9Oka CONTRACTOR EMAIL: toyt.ti4cL di a UMC I . Co++vt <br /> ^ <br /> CONTRACTOR LICENSE#(REQUIRED):AUlU 1VMC,*1)443N"I CITY OF EVERETT BUSINESS LICENSE#{REQUIRED): io7 2() 4* <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 253-to lo .- eiO lro <br /> 0A°^ M'AC \It/ CONTACT EMAIL: , iprrl., 4:li1;_' Vr-t:( •c06-,. <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: bA.kkr00*'^',, Contract Price of Work: $ 1 O r 000 <br /> Proposed Use of Building: ba.-K•t r®.w rt+wo e t,l Heat Source: El D Electric ❑Other <br /> Building Type: El SFR-Detached CISFR-Attached ❑Duplex ❑Multi-Family-#of Units: OCommercial 1 Industrial <br /> Type of Project: ❑New DAddition jegRemodei ❑Repair OT.I. ❑Sign OSprinkler ODemolition ©Change of Use <br /> DESCRIPTION OF WORK: <br /> I e+hod0 to A v)....kivroo., t.= k p j ' 4 s 4vrt S . <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 X Repair <br /> #of List of Fixtures #of List of Fixtures #of #of <br /> List of Fixtures 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 '"S Urinal <br /> Gas Piping Boiler "1 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 /> SINKLER I SUPPRESSION SYSTEM <br /> Chemical or Water ( J 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 State Contractors Law 18.27 RCW and 296.2004 WAC. <br /> City of Everett Official Use Only <br /> �' -- ,°('L'V PES#( $ i o o (o <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />