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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> /11W#11 ----1 <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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1/130 3^a pi, SL PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:CAlejSPAV po52 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 113U N LICK A(Z' <br /> CITY L� � STElepa STATE 4 ZIP 61BZ CO <br /> OWNER PHONE: 75 97$ OWNER EMAIL: <br /> D D «cc4,072,,acrolPs 407)bU41c. cow <br /> CONTRACTOR NAME: ("AAf Z, LteCIMA:r1241ClyeSCA46500ii� C.0A41 <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: 44tc' f-OG4.74..- CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: KOWNER ❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: C1412t,417j PERant CONTACT PHONE: yZ,c-_ 799- <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATIONA <br /> Existing Use of Building: Contract Price of Work:$ �5j I. 00 v� <br /> Proposed Use of Building: sic Heat Source: CI Gas ❑Electric ❑Other <br /> Building Type: )ISFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial [Industrial <br /> Type of Project: ❑New ❑Addition gRemodel ❑Repair ❑TA. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Removi 4,4s G D*444, !4bD on` i2.n <br /> G0,0R'L- AQ 1ITc , I ywwIF 1••� <br /> prkA,lu 104 //act"x.47 4Q r�tAtribo �s sivr�'U <br /> ASSOCIATED BUILDING PERMIT#(if applicable),I <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn I(Alteration _Repair Type of Project: _New _Addn jf,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 /> NC-Air Handling Units ( Heat PumpZ. Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater I t. Bathtub Urinal <br /> Gas Piping Boiler Z.; Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove B Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting ( Dishwasher Roof Drains <br /> 1 Clothes Dryer Hookups Other: I Clothes Washer Medical Gas <br /> 1 Range Hood I Water Heater Other: <br /> Z Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION 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 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 1 >f�/� PERMIT#8 00� <br /> Own. Y3 'zed nature D tS a (Revised <br /> 9 9 9/23/2016) <br />