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OLTPERMIT 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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> .. ,,,;;',aj, PROJE.CT SIT -INFORM TION ,'. h r �� ! ,l�,L� {, sM y <br /> .. li iii 4 � r �.� Wr �t. � rH'r +� a it�'.�° E �... <br /> PROJECT SITE ADDRESS3j 10 [mut j7/- PROPERTY TAX#: �/1� 65O0C/'�1 <br /> LEGAL for new construction: Short Plat/subdivision ,/ Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION, ,lrI ° t, <br /> OWNER NAME: ( I i Clat 1V 1 EL00 c -GAJ.&4 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET3Z10( (A vv Pr <br /> CITY Elyf STATE W4- ZIP Q Z: `7 <br /> OWNER PHONE:NZ5 3j��" OWNER EMAIL: VV �./ <br /> CONTRACTOR NAME: j'IUe.. Flarne / � <br /> CONTRACTOR ADDRESS: STREET 11 Cr Z70 441 l c Qj� 1 ( <br /> CITY I4LT (ST�ATE/vi- ZIP TY <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: iti � ��� i f;/7 <br /> CONTRACTOR LICENSE#(REQUIRED) LUEFF-ti 'S`Y' CITY OF EVERETIT`BUUSINESS LICENS,EL-#l(REQUIRED):O`er .:! 1 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: --ilC-Mn / )hCONTACT EMAIL:I I b' im <br /> ��gintr : <br /> Woofn � � � en,'yi <br /> _ -_,--v:-.BUILDINGPERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$?,C <br /> Proposed Use of Building: Heat Source: ❑Gas UElectric ❑Other <br /> Building Type: NS-FR-Detached ❑SFR-Attached 0 Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New ❑Addition 0 Remodel N1Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> \\Le 3,6G\ YArk AlC 3wrcp <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION:''°`A"'r ', 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 /> 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 Sink(Service/Bar/Mop/etc.) Other: <br /> (SPRINKLER//SUPPRESSION SYSTEM' f'' <br /> Number of Heads 4 <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 lam authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the Stat-Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> / / f -7/7-71 <br /> fry_ _'�� PERMIT r 70 <br /> 0 ' er/, . .;z,1,_.:.: .: __ igna re ' Date (Revised 10/12/2015) <br />