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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> N 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: 1722 /J. Mi1'E tNE VIEW De3VE PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ' CONTACT INFORMATION <br /> OWNER NAME: �� ANTyiON`1S )N C- TENANT NAME(If Commercial): AArrliOlVfS WootprgE <br /> OWNER MAILING ADDRESS: STREET 'O J( 38Ds <br /> CITY gi3tAttvt.t.c __ _ STATE (A)ra, ZIP frQd t <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 6C5r PLN/Y/B/41 e7e0u/P <br /> CONTRACTOR ADDRESS: STREET q/29 5r v6 aml /(I of <br /> circ iTget` STATE % /I ZIP j$`/D,3' <br /> CONTRACTOR PHONE: 70(o 633 I i4-Op CONTRACTOR EMAIL: 8 4AI /N.)j . iSest l l /&O <br /> CONTRACTOR LICENSE#(REQUIRED):'sesTPGa..°1'13Cn CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 3041%C( <br /> PRIMARY CONTACT: 0 OWNER IKCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: �iJ CONTACT PHONE: Zp(o 2.1.{0 14 0( <br /> ?KA-Alb/Al /'/O6bNi CONTACT EMAIL rdpatV1•04 @. S'\'0,.1.Wl1vt n1 .COrrt <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: e ,#c a i/2V1� Contract Price of Work:$ 5-500 eo <br /> Proposed Use of Building: Ze.5'kdN.Ye.4,4 Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: $Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> /n .i// /WV p'iessi :c f �r�cres C eetc34-ritg /o�t�4 �n .6621-fOKs <br /> !e <br /> 4-da`a/t 4- apj rd d-e. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 13\4;09 -000(0 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New Addn Alteration _Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures es List of Fixtures <br /> NC—Air Handling Units Heat Pump Toilet r 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 2. Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting 2. Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan j. Sink(Service/Bar/Mop/etc.) Other: <br /> t KE MACROJ� <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,ori am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with t -State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMI # <br /> 4110 o'v <br /> //24//8 $ D (au\ <br /> 0 -r/Authorized Agent gnature Date (Revised 9/23/2016) <br />