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PERMIT APPLICATION <br /> '111111 -1 <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 7 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: j"?J 1 LaLtm ,t 2. Alt/rye, 9g0-1 1 PROPERTY TAX#:OO /3hi97gx00100 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: gizeleyi A„C TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET '91,07g HD4c pct ; & 1/,43 horn 49A- 9g.aa <br /> CITY STATE. ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: •Bit SI Y'(L[,,iii <br /> CONTRACTOR ADDRESS: STREET ,51o0 /�a._ 5 <br /> CITY ,� ry <br /> not? STATE LOA ZIP Cgc25)0 <br /> CONTRACTOR PHONE: 17101c"ll -51. 57 CONTRACTOR EMAIL: IOW/4(5(64 6,10L(CkS100 •1 e_of)s <br /> CONTRACTOR LICENSE#(REQUIRED):&Iz o kvi7 q77 L CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6 <br /> 7?t't. <br /> PRIMARY CONTACT: 0 OWNER !►CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 41 as-. LI t$- 5331 <br /> rtnicocv on 4 r CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: t)-(-40,Q___Q_, Contract Price of Work:$ IS-0D e <br /> Proposed Use of Building: ecg QQ Heat Source: PGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition Remodel ❑Repair ❑T.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: I1 <br /> Wa9-1f Ck4-� S, C-e-k 11.5 a St cS <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 /> #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 a,, 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 /> I 16-0, hncatan_ <br /> SPRINKLER/SUPPRESSION SYSTEM ) ti a <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 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 Everett Official Use Only <br /> n C 2 <br /> 0 / )O- �D,1 D PE ` \O O\ <br /> Ow r/Authoriz�Agent Signature Date (Revised 9/23/2016) <br />