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PERMIT APPLICATION P2i)06-02,6 <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> WI 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 4.005 P tJ LHUP-ST XV PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: FP-OS 1-i LOOK I-tOMES LLC TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 101400 Q�a Lim sT 5 TH f-2VP <br /> CITY g twit/v�j,.,, STATE WA ZIP `��p(��J®©ci <br /> OWNER PHONE: (..as) Liqq-3,t15 OWNER EMAIL: <br /> CONTRACTOR NAME: rt---t- W N4 VL IPt Q nJ G LLC <br /> CONTRACTOR ADDRESS: STREET 17--ii 6 7 6t 5T 5L <br /> cITY mod ti-0 K. STATE u! " ZIP cis g 7 <br /> CONTRACTOR PHONE: has) n.ti"37-76 CONTRACTOR EMAIL: Elm iN I t U1p1 B1 6 (2 uu t. .Coet <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER I CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Cq a5) n L t -S7-76, <br /> *ib 6iCL v- CONTACT EMAIL: S JM it <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached DDuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: DNew DAddition DRemodel DRepair DT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <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 /> #ofList of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fi ures Fixtures <br /> A/C-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 j~ Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water 1 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 /> O <br /> City of Everett Official Use Only <br /> J �0 ti <br /> 6TH PERMIT# <br /> Owner/Authorized A- Signature Date (Revised 9/23/2016) <br /> A <br /> bt/t,`5/474 .k ad — `/C <br />