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PERMIT APPLICATION <br /> "Illig---- BUILDING / MECHANICAL/PLUMBING/SIGN ISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> vitia 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 25 i-4C Ci 2 4c U �v(1% PROPERTY TAX#: DO s J(y,Q'-S E'3--UOS--O <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ja(24 e 'F' Gl,tliR ,or TENANT NAME(If Commercial): to A <br /> OWNER MAILING ADDRESS: STREET II"/}-(SI- CO 9�+ 7 L ("0A C/10 <br /> � r� <br /> CITY 'earVi X95' STATE (A) ZIP `t..1V <br /> OWNER PHONE: ?( c. •-7 v0•- (4g4.. OWNER EMAIL: <br /> CONTRACTOR NAME: Cl 12E 0v ,1.'r Ki LAD <br /> CONTRACTOR ADDRESS: STREET I 74-1--7_ (S 111 1i)V E i\N- <br /> CR � <br /> Y S /) -L, ` STATE ULM ZIP ci ?-1 •55 <br /> CONTRACTOR PHONE: 20 ^ 244 —q2-2—(p CONTRACTOR EMAIL: 5` lhh-Th @ C/YL4a'-1 i t l o IJtAJ, C4�s✓t <br /> CONTRACTOR LICENSE#(REQUIRED): C,QeL=?43 4 0(1)j Qc CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O5(o'4 4(, <br /> PRIMARY CONTACT: 0 OWNER %CONTRACTOR 0 OTHER(Please Specify) A I'/, A ` ! al..,A IA _ A 1 44 <br /> CONTACT NAME: "--%, CONTACT PHONE: .etZ5 -232 (07,7_1 22 '1Z {ItP <br /> S��1 � <br /> ' i E ,A.ka-D(1R CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION (4✓t 0: <br /> Existing Use of Building: Dui p Lac Contract Price of Work:$ J <br /> Proposed Use of Building: '' )t'I"C-t,- fl3y)'1-� Heat Source: El Gas 'Electric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition ZRemodel 012epair ' ❑T.I. ❑Sign ❑Sprinkler ❑Demolition Mhange of Use <br /> DESCRIPTION OF WORK: Cbt icvt;Ti N[n 7D StNLi L._c j Atm rill OAt(L.1,41'.7 )Jy <br /> 3t OirJrA l 10001.41-1 541 -0,,-it) I ` tAc,r,fc7 sioc,ei ?A,r`l w,t4OJiSt : -PLIte-inti, <br /> -rrcIfe'vj AND, 2-6CartFi@4 L4,a-1r4 lStv'flty OtY\ . <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 #of #of #of <br /> List of Fixtures List of Fixtures List of Fixtures 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-Ct.enA Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains. <br /> Clothes Dryer Hookups Other: 1 Clothes Washer - \l-e/A Medical Gas <br /> Range Hood 1 Water Heater b1'cde 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 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 296.200A WAC. <br /> City of Everett Official Use Only <br /> Z il <br /> PERMITAS <br /> O, .4 <br /> ® (1 <br /> #r" <br /> er/ ut • ized Agen 'ignature Date (Revised 9/23/2016) <br /> / /Z <br />