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PERMIT ' PPUUCATI® IIII <br /> BUILDING/MECHANICAL I PLUMBING I SIGN IPRINKLDR/DEMOLITION <br /> 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 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) P! OJCCT SITE INFORMATION <br /> PROJECT SITE ADDRESS:5l9IO S. 241 Aye PROPERTY TAX#: oc61-$4?f5Q()LI60 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> C_•NT ,CT INFORMATIof N <br /> OWNER NAME:rRa,nc.11 shpe1'1aeg TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5 1I p 3. 2(1d A-v <br /> CITY - -Ni e re- \A STATE ZIP /10203 <br /> OWNER PHONE: X25-422•3 2/.."3 ,p OWNER EMAIL: <br /> �.4 <br /> CONTRACTOR NAME: T ►\ L. 1 JU f n4 I 14tt"f rl <br /> CONTRACTOR ADDRESS: STREET (Lam. 1,&o, fKv e f v <br /> CITY LLinn woc STATE NO ZIP 93d3 7-- <br /> CONTRACTOR <br /> CONTRACTOR PHONE: 425• 4-4S•lji4{,o f CONTRACTOR EMAIL: I?j(y�(1@0. ` 7 ni-k. net- I <br /> CONTRACTOR LICENSE#(REQUIRED):DAYNi2rPtic'iLILl2Q CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O 1 f 741 <br /> PRIMARY CONTACT: 0 OWNER (CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: Br(.10.4-1 T( , ad G 1 i 4.--P CONTACT PHONE: 4.1-2'j• —4-4S-(y t/(gi4 <br /> CONTACT EMAIL: ,('yail <br /> �hal arida j . Pel <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ /3;CO o CO <br /> Eroposed Use of Building: • Heat Source: kitGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached CR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New Addition ❑Remodel ❑Repair DT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 9.t* IG•u2.. a si•Anq ci&s 4 AA r4C2.. v.)'-K' y\W-> ca.b - ivn -may mop, �e <br /> LOOC TIO►t)• 41.50 _ 5-1--;44-1.- /O 0/Jet-0 6 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): PIAN 6- 7V 5 D l fFM'6 f o(,(T , <br /> MECHANICAL PERMIT APPLICATION PLUM;ING 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 #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> 'A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> sForced 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 /> I Gas Range Ducting Dishwasher Roof Drains <br /> 1 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/SUPPRESSIQN 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 /> _Irrent 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 /> wilding Official before being authorized under any circumstance.1 am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> —id I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 1 �•- t l <br /> PEMv l# \ \ \ ` <br /> Ow e uth ized Signature Date (Revised 9/23/2016) <br />