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PERMIT APPLICATION <br /> °I.14<al /111,-°.:4— BUILDING / MECHANICAL/PLUMBING /SIGN / SPRINKLER/ 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)everettepsieverettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION �n <br /> PROJECT SITE ADDRESS: 2,132 D.f2O/k W A y PROPERTY TAX#: X q 3q/43.70/700 <br /> LEGAL for new construction: Short Plat/subdivision / Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION / <br /> OWNER NAME: ykL S M �,[� Y TENANT NAME{If Commercial): �()G.JW i M� gpSt <br /> OWNER MAILING ADDRESS: STREET iJ 1L�,r,,3�12� P. h <br /> / <br /> CITY GV G 11- � STATE WA- ZIP W2,0/ <br /> OWNER PHONE: 2.06 1(,3 -l 3s OWNER EMAIL: r"094.) StN�L!Li/ @ I-YY(a,t/• CtT)--t <br /> CONTRACTOR NAME: V oLV 0,1N '1-12VCGT11 IQ Com PAI01 1 LL—C. <br /> CONTRACTOR ADDRESS: STREET 22/,2 5 R,QC K E FEU-EJ& .,. ..t/e--- <br /> CI, <br /> VS �ry�/►�� <br /> �7 ,,� CITY E1/EIZ E� ,/�,S,TATE W n ZIP TrIC)/ <br /> /{.._ <br /> CONTRACTOR PHONE: 249(3 g IJ I i' 30/ f CONTRACTOR EMAIL: t+1 •V 01 k (Q(, OW)C,it.5''"' •AL, 1 <br /> CONTRACTOR LICENSE#(REQUIRED): V L� cGc crOUf M CITY OF EVERETT'BUSINESS LICENSE#(REQUIRED): 251 -4 S <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR PCOTHER(Please Specify) ARL 14 I -7 <br /> - <br /> CONTACT NAME: CONTACT PHONE: 6 - S,511 „ 1412_ <br /> M0Y -CSAN ELL 10Tr CONTACT EMAIL: 1/4pray.► kolcoarte,IIt0/{-l` '%pLAli , <br /> BUILDING PERMIT APPLICATION ' <br /> Existing Use of Building: v WA 1`''f CLI 0 t C_ Contract Price of Work:$ ' IR 2'U ,; ► -ow. ' <br /> Proposed Use of Building: A M t Heat Source: Gas ❑Electric ❑Other VL 2?b <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ,'Commercial ❑Industrial <br /> Type of Project: ONew f/rAddition Remodel ❑Repair ❑T.1. ❑Sign El Sprinkler ❑ emoli ❑ Use <br /> Dtion Change of <br /> DESCRIPTION OF WORK: 699 SF. AA�Dl'a� )ij(mak,1't1G RM',DEL 0f_ <br /> c 1 -rj G L-Q 9 Ai2EA AND “N;TROC1)vN oQ �Agp �p <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 List of Fixtures List of Fixtures #°f 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 /> 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 /> Chemical or Water I INo.of Heads <br /> ACKNOWLEDGEMENT:!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.l am the owner,ori 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 /> PERMIT# <br /> , t70 (Z <br /> Owner/Authoriz gent Signature ate (Revised 9/23/2016) <br /> j0.. <br />