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477" PERMIT APPLICATIT1''II <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 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2.4 Z_ ) (SV €. ' Y &t PROPERTY TAX#: 00.11,Y1j-- U O _(333 00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: q111.9L(A/1li/Irl eAl' y4/4CS' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (0)2_ C.4 , /' u oI t (i <br /> CITY LAV'- l o-2 STATE ZIP ' <br /> OWNER PHONE: 2-{hD,SSE)• Db Th, OWNER EMAIL: e}ASL,LA. u S <br /> CONTRACTOR NAME: 2..El Dee);v.% U C 1 Littjoieti Cak ( ; ?Lomat. fitkei N4 <br /> CONTRACTOR ADDRESS: STREET 110 i 10 44-- Si- PCD'[bi'S4S11A LS/� - <br /> CITY 7 <br /> t� STATE W�- <br /> ZIP 9Q Q7? /0 <br /> CONTRACTOR PHONE: —62A--3 U m-ZS CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE##(�(REQUIRED): 2...618)%":. Du$'5`,i,., 'CS CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): kQfL <br /> PRIMARY CONTACT: C17OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: "1"411441- <br /> CONTACT PHONE: ... W�,00 <br /> r�f'�' e'elii L �®1"4 CONTACT EMAIL: g. `INSK". <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building:. SAP-- Contract Price of Work:$ Z-S-.1 0/30 <br /> Proposed Use of Building: (L Heat Source: ❑Gas 1 iElectric ❑Other <br /> Building Type: Lr15FR-Detached ❑SFR-Attached ODuplex 0Multi-Family4 of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition Qemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: "4 (11 <br /> G 1,0_ ,11,4,I✓uk,e1 aelet wad, ,U4 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION� PLUMBING PERMIT APPLICATION <br /> Type of Project: New_ Addn i4lteration _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 Z Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 1 • Bathtub Urinal <br /> Gas Piping Boiler 'r'{ Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration V Shower Floor Drain <br /> Gas Fireplace Wood Stove t Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting 1 Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: 1 Clothes Washer Medical Gas <br /> l Range Hood Water Heater Other: <br /> 1 Exhaust Fan 1 AT Sink(Service/Bar/Mop/etc.) Other: <br /> kAhVadAvtig <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 /> PERMIT# �i 3 <br /> 3/t1 7 o �3 <br /> Owner/.4 orized Agent Signature Date (Revised 9/23/2016) <br />