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4r877 PERMIT APPLICATION IIIIIIIIIIII II <br /> BUILDING—MHANICAL/PLUMBING/SIGN/SPR7I4IILER/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 I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: <br /> 1??Li3 ROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: braj .3 e.4r - TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 13 Ld3 d rorvn, Aii <br /> CITY Eve/'-1-4[ STATE L ZIP `I 3T20 3 <br /> OWNER PHONE: ;,),Z`,5 z- z-144, OWNER EMAIL: <br /> CONTRACTOR NAME: Refs"A C yt. "ru h'iei k,e_, <br /> CONTRACTOR ADDRESS: STREET /O2/ i LI 1.6 St 5k) <br /> CITY 6i.r.A`-ar , STATE WA ZIP 9,r24)Li <br /> CONTRACTOR PHONE: Liz .'1.Li 1 2.- 31-dg CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): 139,,,(5i2,;iL,76ja CITY OFEVERETTBUSINESSLICENSE#(REQUIRED): 04,5 17 <br /> _ <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: z425 - 77Z- 75 LJ o <br /> N(h`t iNe.,n 332.1,5 t71 CONTACT EMAIL: 6,,n4'o.v� @ ,.n„i4, ,c,, .C.r✓m <br /> BUILDING PERMIT APPLICATION ) <br /> Existing Use of Building: Contract Price of Work:$ �2'& /•C <br /> Proposed Use of Building: Heat Source: 0 Gas 0 Electric 0 Other <br /> Building Type: 0 SFR-Detached 0 SFR-Attached 0 Duplex 0 Multi-Family-#of Units: 0 Commercial 0 Industrial <br /> Type of Project: 0 New 0 Addition 0 Remodel 0 Repair 0 T.I. 0 Sign 0 Sprinkler 0 Demolition 0 Change of Use <br /> DESCRIPTION OF WORK: <br /> gm 191pi. - (iviA kokv fp it/10L i it A Ae/ei. <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 /> 0 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 <br /> Number 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 1 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 /> dr PERMIT# <br /> .A4`--1111 2'...? 1 0102 5—-DY?)I <br /> Ow -rlA - • ed ' •-'.-ignature D e (Revised 10/12/2015) <br /> mel <br /> LDC 0(2.." <br />