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PE"MIT ��PPUCATIO� <br /> UILDING I MECHANICAL I PLUMBING I SIGN I SF•�RINKLER I I EMOUITION <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 I www.everettwa.gov/permits <br /> (Blue or lack Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 201.-Ai/g'/L/ 4'109201.- 19 Q <br /> G V e gg23 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: V[eta V .. L.L 6i — bilk lays 0,11TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2.(,2O s$' S- S 4) <br /> CITY 1d,E,f.,�f/- STATE ifolA ZIP gg20 3 <br /> OWNER PHONE: N20 % g^ $2$S OWNER EMAIL: pla.ie Lot,v-se I,,J r. Iwea, e 044 <br /> X CONTRACTOR NAME: gd )g Gp-t,�,1.•Q„L� <br /> CONTRACTOR ADDRESS: STREET ?. D. Ij esx. Z 3 s-- <br /> yy�� <br /> CITY )14 2 et 11 STATE it,ii ZIP 477 Z,/9 <br /> CONTRACTOR PHONE: 0.-.. C f?, 'I&3y��- D2.7 2_ CONTRACTOR EMAIL: e p4$C.. q CAM.- (Q 14,401.1.e CIA-t_ <br /> LICENSE#(REQUIRED): D 5 c.DG.-q t/2.L 6_ CITY OF EVERETT BUSINESS LICENSE#(RE/QUIREIy <br /> PRIMARY CONTACT: X OWNER 0 CONTRACTOR 0 OTHER(Please Specify)6.-___./ <br /> ' i r r il,% rCONTACT NAME: CONTACT PHONE: 2 j ills" T Z g'g I <br /> Det-I 1.-4-fr.5OA) CONTACT EMAIL: „At (E LeI,Y$D.tJ J J . 10 •'�i - %J. , <br /> � <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: S//l)ey Le,) n .�c !y � Contract Price of Work:$t -3 DOC • a <br /> Proposed Use of Building: cc-v.(1,-LP P724,,,,.., 6.,yG06-it t/ Heat Source: ❑Gas ggElectric ❑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 /> 'bete i�- PACII /2 -orial/4J -- fes- it, /6-1--ti- /-- <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 /> NC-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/SUPPRESSION SYSTEM <br /> Chemical or Water O 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 /> C PERMI It?) <br /> 62-01 6 ,...., <br /> Owner/Authori ed Agent Signature Date (Revised /23/2016) <br /> I! <br />