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47ETT PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINK / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES ORIGINAL <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> mss, :, :t'',.:',:!',:''-,''','"'F .!,';:' PROJECT SITE INFORMATION' ; r. <br /> PROJECT SITE ADDRESS:gip <br /> (i rarla n a PROPERTY TAX#: 003857117.501600 <br /> LEGAL for new construction: Short Plat/subdivision �J VC Lot No. (aatttach copy of long legaldescription) <br /> CONTACT INFORMATION,.. <br /> OWNER NAME: Ori Mi- h TENANT NAME(If Commercial): <br /> s <br /> OWNER MAILING ADD SS: STREET'fl (Iran rive <br /> ° CITY Evevvz� STATE�J I <br /> ZIP VW <br /> i1/�o- <br /> OWNER PHONE: -3✓-/-b W OWNER EMAIL: �����/// <br /> CONTRACTOR NAME: IS`(fig Flamm <br /> CONTRACTOR ADDRESS: STREET itt '7,^�,�_ 59 360 #1 �q/)��' <br /> CITY U/��K�IV e- .evv ,(f STATE ZIP g7[l�( 1 <br /> CONTRACTOR PHONE:q7,5----77b-7- 7_61 PP111111"�""'LLL CO/NT•RA7CTOR EMAIL:ir]J®plv,�n(J,7 ( VVV_`�✓ i 72 ! <br /> CONTRACTOR LICENSE#(REQUIRED): 1IFF 1031 M CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):(05� <br /> PRIMARY CONTACT: 0 OWNER -CONTRACTOR 0 OTHER(Please Specify) <br /> CONT\-t&inaV <br /> CT NAME: CONTACT PHONE: 117- 71) - 1`- q <br /> h aoencie <br /> CONTACT EMAIL: 1��� �(S� . ,--,-, <br /> __-_-„--,-s - _,_,_ i ' BUILDING PERMIT APPLICATION. <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: INeas ❑Electric ❑Other <br /> Building Type: _ ‘R-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: El Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodelfiepair CIT.!. ❑Sign CI Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: J <br /> ill- kArna ? civny vt. <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 /> 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 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 /> Number 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.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 /> g`/f/g P`rn ` - 025 <br /> Owner/, .• '.a. ,^?' ignature Date (Revised 10/12/2 <br />