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• <br /> PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> IA://f/:::.A. CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.govlpermits <br /> s- r <br /> ;(Blue or Black Ink Only Please) ;.PR.OJECT,SITE INFORMATION w ,, <br /> PROJECT SITE ADDRESS: 101D `JE EV/ 9- Mika_ topt.,.e PROPERTY TAX#: Z&, le:0050 k° <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: t\teCUzf-r. 11.01ALL 0r e.E "goitz ac UVA‘41,40kTENANT NAME(If Commercial): V <br /> OWNER MAILING ADDRESS: STREET �� A%M'''r) A 5Z1 <br /> CITY S%`11:4401/41 ►-1- STATE LIA, ZIP `QJel Q <br /> OWNER PHONE: 425.X30. ( 3 'Z, OWNER EMAIL: cY/� y...ic4- toy e. l��.f-..1P1 ,rt--e • Cory) <br /> NAME: _ 'v: ( oMM6iU IAL ?/IAP i-/ ita ANice, 006 <br /> CONTRACTOR ADDRESS: STREET pa 507( //ZS <br /> CITY /6//00e5i STATE u'A ZIP ! z. /Z <br /> CONTRACTOR PHONE: (360" g -61-70 CONTRACTOR EMAIL: 5-bo,...t @ G',v ivlt t9. ,...ow, <br /> CONTRACTOR LICENSE#(REQUIRED): LL CMjy FGL3o2 LI CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0 Z 79 O Q/p <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR .OTHER(Please Specify) 11!t1T <br /> CONTACT NAME: CONTACT PHONE: 'LO(p. ajl. Slei-z„ <br /> C 1Lj `V.8 <br /> -c - t'-r CONTACT EMAIL: a‘d'•S C r C,10‘..c •w1 <br /> k BUILDING PERMIT APPLICATION ,✓ <br /> Existing Use of Building: C:Y1(l Contract Price of Work:$ ' 00/ Ov <br /> Proposed Use of Building: (jam Heat Source: ❑Gas • lectric •ether <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: „ immercial ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair VkI. OSign OSprinkler ODemolition OChange of Use <br /> DESCRIPTION OF WORK: NSW C>C%U2 OU V 1 ,�"� <br /> Lam,{ �I�j'tl 1.1� S'Plk(.E . M -1"`1 V66111'S1o►1/j, <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 Fixture <br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Ur al <br /> Gas Piping Boiler Lavatory(Wash Basin) ° rrinking Fountain <br /> Water HeaterRefrigeration Shower Floor Drain <br /> Gas Fireplace f Wood Stove Kitchen Sink& ■'posal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Drye. ookups `a Other: Clothes .sher 140.4%, Medical Gas <br /> Range Ho Water .eater Other: <br /> Exhaus an 1 Sin ervice/Bar/Mop/etc.) Other: <br /> SP-; KLER/SUPPRESSION SYSTEM <br /> Chemical or Water ' 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 b- .re being a orized 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 1 comply w" the State Contra ors Law 18. RC W and 296.200A WAC. <br /> 641 <br /> City of Everett Official Use Only <br /> biti -1 <br /> /634 <br /> PERMIT# 170g -0 1 <br /> Owner/Aut : •- t Signattle Da (Revised 9/23/2016) t <br /> 2- <br />