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• <br /> PERMIT APPLICATIOrJ <br /> 04pr BUILDING I MECHANICAL I PLUMBING/SIGN I SPRINKLER I DEMOLITION <br /> CI-1'1'0F 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®r Black Ink®.nly-Please] PROJECT`SITE INW®RMATION •• • • - . _ <br /> PROJECT SITE ADDRESS: '3/1P5— /911iif • 1 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> . _ • .CONTACT.INFORMATION . • . <br /> OWNER NAME: //• <br /> l)s fit. /.10;61-A.4-/ti �l�f- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /19 )'.L m,cy*c— tr s'ns M5 p <br /> ICITY 8�j/� "d 9 STATE 144 ZIP 2.2c <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: E U1 K.C.AE AJ 7-74---nI'4& c.. <br /> CONTRACTOR ADDRESS: STREET 2( -o Cilc Au <br /> gir <br /> (( <br /> CITY U!'sY[�T STATE (A) ZIP 1S20i <br /> CONTRACTOR PHONE: 1 ..5-2.5 2.-" /1(4 • CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): EV raa.SS®2,so-1- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): C'ori1 c-, <br /> PRIMARY CONTACT: 0 OWNER KCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4 75-25'2.d,//9 <br /> Amok hk.._id <br /> CONTACT EMAIL: <br /> iimitic C E,55,41 wA_Cep <br /> . - BUILDING PERMIT APPLICATION • . - . . , - <br /> Existing Use of Building: I Contract Price of Work:$ a 3,000 _ <br /> Proposed Use of Building: Heat Source: IiGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Units: EgCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel Ii4Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition El Change of Use <br /> DESCRIPTIONOF WORK: P01400(if L1 72,/1t S CX 7E; SIX <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> : -ME CIWAN!CAL.PERMIT APPLICATI®N . . - . PLUMBING PERMIT APPLICATION <br /> Type of Project: New _ Addn Alteration F 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 /> 2.— 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 R• efrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal P 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 /> 'BIPRINKLER!SUPPRESSI®N SYSTEillii . <br /> Number 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.lam the owner,or 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 /> / <br /> 1 /e! Z3/77 PER - — 0,,,,,,,,..____„, <br /> Ltir�er/Authorize Agent Signature Date (Revised 5/20/216) ( <br />