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PERMIT APPLICATION <br /> 40040.. BUILDING/ MECHANICAL I PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (B(cae®r Black Ink Onty.Please) • PROJECT SITE INFORMATION - . <br /> PROJECT SITE ADDRESS: I 0 t+b1 A 02-IP&-A 120 PROPERTY TAX#: <br /> LEGAL for new construction: Short Platisubdivision Lot No. (attach copy of long legal description) <br /> - . -CONTACT,INFORMATION . . _ . <br /> OWNER NAME: 5Q t`'1t4 St Sjv V i TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 9qq 1 1A 1mA/491'O 70 At P,0,&o K 'Z-`�.`j p A . <br /> f / CITY isV y`:IIL STATE INA- ZIP I8 !)3' <br /> OWNER PHONE: t4yU ih. (,k. OWNER EMAIL: N K,,,,t C'w 5 fTNt' ..,, ((.... 0 - <br /> CONTRACTOR NAME: <br /> ..CU ..G A.) ..,..67-- rTEC GaOC `Wt ,.., ._....,.... ._.- <br /> CONTRACTOR ADDRESS: STREET '2-r2.-C) Pmt Ipt,C. Au c <br /> ITY ✓v0(2 T STATE (AI A.—. ZIP /S20 <br /> CONTRACTOR PHONE: 4...2-5--2.5-2•-'5/Kt • CONTRACTOR EMAIL: Mikitka i- SMi014 ,c0.. <br /> CONTRACTOR LiCENSE#(REQUIRED): COG-1245S 02.20 r CITY OF EVERETT BUSINESS LiCENSE#(REQUIRED): ('ori a c-- <br /> PRiMARY CONTACT: 0 OWNER RCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: A CONTACT PHONE: 4 Z 5 2-5'2-,ll 9 <br /> tuLtpak fi!ix CONTACT EMAIL: mA -e.16C tJ2A • <br /> .• LD <br /> BUILDING PERiVi1T APPLICATION '- • - . ' " - - • . - • - <br /> Existing Use of Building: 1 I Contract Price of Work:$ ?5(.5-6 :po <br /> Proposed Use of Building: NO E (gt( Heat Source: ❑Gas 17f€Iectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: FiCommercial ❑industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair DT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: o""t,G imatibmit, Q� j o& f.t.k Cj tj •-2\oD by(„T� 5 foxii , . <br /> t N OW DO A( etrAbrol 4&t- -'6 d�" <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> :MECHANICAL.PERMIT APPLiCATION " • . PLUMBING PERMIT APPLICATION <br /> Type of Project: _New J Addn 1`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 /> t 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 /> • <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> . :. 0n16ICLER% 11PPRESSION 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/am authorized by the owner of this properly to perform the work for which application is made, <br /> and I comply with the State Contractors Law 78.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> -moi 3((q ( � k ( g"D• - 040 <br /> Owner/Authorize. t Signature Date (Revised 5/20/2016) / '` <br /> • <br />