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elPPERMIT APPLICATION■ <br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> J CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov J www.everettwa.gov/permits <br /> (Blue,or Black Ink Only Please).. .PROJECT SI INFOR TON - -':-k.;'-!,' <br /> t. <br /> PROJECT SITE ADDRESS:,9-n'J'1C) P\Qpn,,&I At PROPERTY TAX#: OW/4q(Qt9-7Zo <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION , <br /> OWNER NAME: FyirojAA, 01 CCOLA (.. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET GQj^c �I i E i cs'- <br /> CITY K-C�/(r,®p-e, STATE A- I <br /> y _ t ZIP 9g a8 <br /> OWNER PHONE:�(k al-)9y q¶ 1 OWNER EMAIL: S OlCc4C Y1.(L e ll.,.Tr ni t -Coat - <br /> CONTRACTOR NAME: Ki 4/,Oire tt4 LVL`C� <br /> CONTRACTOR ADDRESS: stdEET )B0,233 boy (21 <br /> CITY (..-.J 0 0 WOO STATE LA ZIP q803(0 <br /> 5! <br /> CONTRACTOR PHONE:(1 I5) — (S-7j CONTRACTOR EMAIL: Oil&cal a FP fr--iiiii <br /> ( 5, e CAW\ <br /> CONTRACTOR LICENSE#(REQUIRED):) //'f st11l l 4/4CITY OF EVERETT BUSINESS LICENSE# UI <br /> (REQRED): <br /> PRIMARY CONTACT: Kr OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 690(.0) g9.4 qs-62 1 <br /> Seirck Mc-Wr(P ( CONTACT EMAIL: 5mcCo M1L@Vw - Y`Ct,1(.co.en <br /> !BUILDING`PERMIT APPLICAT10)*' "' <br /> Existing Use of Building: Contract Price of Work:$ J 3s-c) <br /> Proposed Use of Building: Heat Source: XGas ❑Electric ❑Other <br /> Building Type: eSFR-Detached OSFR-Attached ❑Duplex ❑Multi-Family-#of Units: OCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair CIT.!. OSign ❑Sprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: n G <br /> `eplCi.F;<ft 1,6o `N/0G-u 1i �Ot' 1;1144-- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERAIT.APPLICAI ION -' „ • ' PLUMBING"PERK i IT APPLICATIO1M <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 /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> f 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/SUIPPRESSION.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 b=.g authorized under any circumstance.lam 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 wit the " - =Cont a: .rs ;w "a' and 296.200A WAC. <br /> City of Everett Official Use Only <br /> / # <br /> ��- A 1C$ PERMIT IM lO IZJb 0'3 <br /> •wner/Authorized Ag t S .,. ure Date (Revised 9/23/2016) <br />