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PERMIT APPLICATION— <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 /> Iue.,or B a - k,OnlyXPlease?.4. . ,PRO EGT SITE INFOIRMATION p i Mli ,. <br /> PROJECT SITE ADDRESS: /a3 V/f T- r.1) PROPERTY TAX#:C6437?-5440 1O [QO <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ;CONTACT INFORM-016W. <br /> OWNER NAME: 57-Eye A HU,U TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET P423 V ilcin//A- �►n1/-c <br /> CITY Etr E-1-7- STATE Lx)/1- ZIP q��l <br /> b <br /> OWNER PHONE:25 -332 Zo 7 OWNER EMAIL: <br /> CONTRACTOR NAME: tAy S--/vire Plum glA)6- d-17 -1-l4(7- <br /> CONTRACTOR <br /> (7-CONTRACTOR ADDRESS: STREET i4.6./14 13 Ar-uk.p. Le) <br /> CITY �/� i�/(/tQc197 STATE LA-1h' ZIP 0-0 37 <br /> CONTRACTOR PHONE: 42. -7-251_6c/65 L( CONTRACTOR EMAIL: Sl te4"J @()AA-eq./vo yV rre .Yl/2T- <br /> CONTRACTOR LICENSE#(REQUIRED):Df t(Nv,ZPI+qC.f Lf R..,Q CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) Ola71-1 <br /> PRIMARY CONTACT: 0 OWNER [CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4-2.5_-779_6q L.(,e X� y\i ���I u CONTACT EMAIL: e pl i p � t <br /> BUILDING PERMIT APPLICATION �, . <br /> —cisting Use of Building: Contract Price of Work:$ // gel 7.75 <br /> -4oposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other _ <br /> Building Type: ❑SFR-Detached .SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demoolitiion ❑Change of Use <br /> DESCRIPTION OF WORK: it) PLli ms,A19 F- &A',,t 260 1V&i AN0 LAW/Dic--(6._ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION, ;.=, j PLUMBING.-PERMIT APPLICATION; <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn XAlteration _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 g, 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 I 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 J No. of Heads <br /> KNOWLEDGEMENT.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 /> Trent 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 /> _hiding 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 Everett2Official Use Only <br /> / / / 2 PERMIT#, L U O % " ®L <br /> Own• 'ut i• zed Agent Signature Date (Revised 9/23/2016) <br />