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,IIP.,/,‘,.--,. PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN /SPRINKLER/ DEMOLITION <br /> vezi .."- <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 ) FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) �,,PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ( [L �(' . or sg' PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision ____--Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Joe.. LaYVIAD TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5 it +'t' <br /> CITY , /fi[� jf r ��h��(��� �,�!"'Jy y4 <br /> "�..,,�.}/ VY STATE !Ti ... ZIP L4 <br /> OWNER PHONE: OWNER EMAIL: ! i [ <br /> r <br /> CONTRACTOR NAME (XVI t tiei'T f6 <br /> CONTRACTOR ADDRESS: STREET 146 )y-c)cad WA. yy�� <br /> CCP'Y e/!w. M � ,`�-i� STATE n a 0 V 2 1 <br /> CONTRACTOR PHONE:L " 5 X51 01G,y, CONTRACTOR EMAIL: d C'f bl e r c..41,itileo t1✓l@ . corn <br /> CONTRACTOR LICENSE#tREQUIRED):C r I t�`'&A.rV\,Vk 1JZ4J nCITY OF EVERETT BUSINESS LICENSE#(REQUIRED)• 1V -'{5 <br /> PRIMARY CONTACT: 0 OWNER t I CONTRACTOR 0 OTHER(Please Specify) _ _ <br /> CONTACT NAME: CONTACT PHONE: a5 ;S b <br /> �tv ........ . <br /> CONTACT EMAIL: ,- ei of C.rKke incl •Et)nel <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building. Contract Price of Work: $ 51,.... .„._ <br /> pof Building. Heat Source: as ❑Electric CI Pao od Use ..— �. <br /> Building Type: ? SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Famiiy-#o s: ❑Commercial ❑Industrial <br /> Type of Project. ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ©Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ()Irt rias. pi pia/ -}v ren e bb Q <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 #of <br /> Fixtures List of Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> 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 /> ..-1 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 /> . <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 1 SUPPRESSION SYSTEM <br /> Chemical or Water ( 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.lam the owner,or tam authorized by the owner of this property to perform the work for which application is made. <br /> and I comply with the Stale Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> V� :, g = ,, -t I <br /> PERMIT# .�^ 11° -61C <br /> Towne(Authorized Agen ignature Date IRevised912312016) <br />