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IIII II PERMIT APPLICATIOI—f'IIri <br /> ',—.‘ BUILDIN�NECHANICAL i PLUMBING I <br /> SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: `Z S [ °3/ 14-d 1Z PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision l Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: kJ.tSpi/V'r STEa Q{eS ht kv:i.A./ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2 3'3( 14.0ct A.e-,. - , <br /> CITY STATE t414— <br /> K/4ZIP 7 a Ze r <br /> 1.2+- <br /> OWNER PHONE: " -- Zs'Z -37 07 OWNER EMAIL: F'ZlD E£. Q. 0 reKiT'(£(t ; Covin <br /> CONTRACTOR NAME; 6 co Avis a ,/S flik,e p J\ <br /> CONTRACTOR ADDRESS: STREET*+ -11 ( 2 '7.=Z. S <br /> CITY �'€L./ IOdPMSk. STATE (J44"- ZIP y$ z1-0 <br /> CONTRACTOR PHONE: 25' Y 3 - J 2 CONTRACTOR EMAIL: L(aAII5 40.16-0,, <br /> ,,,,to`I <br /> CONTRACTOR LICENSE#(REQUIRED): 1,00/411 C 4. j 6.1 P CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): d to <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 142-r'''3(l/il~ -c3 <br /> y /14/5 CONTACT EMAIL: Lao 1i Si 0 46e, co AI <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Ofti f24, , '_- ` Contract Price of Work:$ 43S00 0 <br /> Proposed Use of Building: (°( Ut ,t4 Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: Kommercial El Industrial <br /> Type of Project: ❑New DAddition DRemodel DRepair DT.I. ❑Sign ❑Sprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> R- _ 1100 P/i4e, <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 /> 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 /> Range Hood Water Heater 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 auth..lzed 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 with the State Contra vs -^:.-;;Ar4454C__„, <br /> 1 City of Everett Official Use Only <br /> ��` (t7t (17 <br /> PERMIT#6l 04.....,022_,Owner/Authori •d Agent Signa re Datle 1 (Revised 9/23/2016) <br />