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PERMIT APPLICATIO• <br /> � BUILDING / MECHANICAL/ PLUMBING /SIGN /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: 721 to LPtt1Pd4 Aft., ‘fee-if It//„A 9Q 2,0) PROPERTY TAX#:003€172-•240-a�b-eO <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: _ thr m find a/rase©. T✓✓C(d s TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET c,2427 fad e gz -AJE <br /> CITY 114 I I S(1I I e STATE WA- ZIP10.7 <br /> OWNER PHONE:4' . 289_4,ggO/4/yg-3yy_ Z ! OWNER EMAIL: p_ciyr,/h(/t�7l7'z. )4/,,a0,cavh <br /> CONTRACTOR NAME: Ulf/ytri0j "4 Jf <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ;OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 90J' MI/NO 2- CONTACT PHONE: t/gf'Zc9.-101D / u"--. 15/9--ZZ��( <br /> s� G/v __11 <br /> vQ, ✓Vy CONTACT EMAIL: p p�y-i�'IVir7 `cep u6`h0Oz.CjM <br /> `_I"-- <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Re 5Iden C . Contract Price of Work:$ 2-Ci 06D <br /> Proposed Use of Building: Res i cieJ"C& Heat Source: ❑Gas )6Iectric DOther <br /> Building Type: DSFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New ['Addition Remodel DRepair ❑T.I. ❑Sign ['Sprinkler ['Demolition ['Change of Use <br /> DESCRIPTION OF WORK:. An efi b 4)sen ee+ w;i/ be Coil der I e r 1-'9 a l iwkle. Spo,ce,,,A o he bed Yo,nN <br /> Avid one )s k1 J even. g/913' 4,, R!-Pia. Win dc Wed 45 l4,14c(r J }-4:310Y)). 1�F " 6.f-� bctSe/heA+ <br /> Will Fe'hair AS ay <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 #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump 1 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater .. Bathtub Urinal <br /> Gas Piping Boiler L Lavatory(Wash Basin) Drinking Fountain <br /> I Water Heater Refrigeration y Shower 1. Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> f 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 /> 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 ate Contractors Law 18.27 RCW and 296.200A WAC. <br />' C9 I /y�ig City of Everett Official se <br /> `/��•l/ l l RMIT <br /> Owner/Authorized Ag l Signature Date vised 9/23/2016) &i✓ p�C I 2._6O ' <br /> (7 `ll- <br />