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PERMIT A PPLICATIO= <br /> BUILDING/MEC} {ANICAL/ PLUMBING/SIGN /SPRI-KLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 477- 3200 CEDAR STREET,EVERETT,WA 982E <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettw, gov I www.everettwa.gov/permits <br /> (Aute or lack ink Only Piease) PROJECT SITE INFORMATi I - <br /> PROJECT SITE ADDRESS: E.,110 94," Ali L, \iv JC't-Ft WA 133101AROPERTY AX#: Z KO (C 60 A 7o0 <br /> LEGAL for new construction: Short lat/subdivision Lot No. (attach copy o nig d cription) <br /> CONTACT INIF RMATiON <br /> OWNER NAME: rat' (.1 >„A, \r®„,,e_ 14t,nti!C iro()4A1TEiM . teinntetcial): <br /> OWNER MAILING ADDRESS: STREET 2.6 cif tL ) tx � Z.C_ <br /> 5'C(.E` It CITY STATE N A . ZIP( V I ,„1 <br /> OWNER PHONE: '1 86( 1._ Q2 4", OWNER EMAIL: t3o\,,vl*s4o q...,()44\\Ani •(.P it NJ i'.( \?. O.-4/k <br /> ti <br /> CONTRACTOR NAME: Ists Ce514� ✓a� ,.� <br /> . �/oc <br /> CONTRACTOR ADDRESS: STREET 14A0 gecl .3-1 t 1 sq./ sec'c Ji c L A Qui c' <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: a 3 t <br /> SC f0 �p(`CONTRACTOR EMAIL: 66 6 cd.Brea'li!`cjcta�� 1k �f I. c' <br /> it.?c;t e y,\, <br /> t <br /> CONTRACTOR LICENSE#(REQUIRED): I J( L -t 1113 1 k. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5-6g et 9 <br /> PRIMARY CONTACT: 0 OWNER tii CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: ern e�k CONTACT PHONE: 3 co& gra 0 <br /> d CONTACT EMAIL: uo t in,s71/(r r '1 AC e c9!/vici ,- ICe)coq, . <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ /0g270., <br /> Proposed Use of Building: • Heat Source: @Gas DElectric @Other <br /> Building Type: @SFR-Detached @SFR-Attached @Duplex 1:1Multi-Family4#of Units: @Commercial El Industrial <br /> Type of Project El New @Addition DRemodel @Repair DT.I. OSign Ell Sprinkler @Demolition @Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): av IIDiJ.L I b I r 1 i t,/ Avis . <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 #°f List of Fixtures #of 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 /> 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/SUPPRESSiO SYSTEM <br /> ! _ <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 RCW and 296.200A WAC. <br /> N1 City of Everett Official Use Only <br /> i PERMIT#I / <br /> ISO I' <br /> 0 • er/Auth.rizedAge--- <br /> e Date (Revised 9/233///2,016) <br /> ti <br />