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PERMIT APPLICATIOI— <br /> � �s-- BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRIN ER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> I'�'*" .tici 3200 CEDAR STREET,EVERETT,WA 98201 6L Q <br /> P 425-257-8810 FAX 425-257-88571(E)everette s everettwa. ov ev ettwa. ov/ ermitts <br /> ( } FAX P@ 9 I e'( 9 p <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION \` <br /> PROJECT SITE ADDRESS: 114% PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> / CONTACT INFORMATION <br /> OWNER NAME: A V Liv,..... &NI nn TENANT NAME(If Commercial): 3'f l o \ <br /> r ,„,,e,vb <br /> OWNER MAILING ADDRESS: STREET 1c2(I 5" j9/914" 11‘,.t Sr <br /> CITY Eve I,c W STATE cj A ZIP c 1 aO(� <br /> X <br /> OWNER PHONE: iiaa j5—.. 337— 5' 3 OWNER EMAIL: 5i Iv';r I//G ke it 0 ie�54 -.curt'► <br /> CONTRACTOR NAME: c,Sp(,Jfl, r ( / o <br /> CONTRACTOR ADDRESS: STREET (319 gp,)!lq'1G/1 SI- <br /> CITY <br /> t:CITY 4 6)(0,01,44 f' STATE lJ 4 ZIP a 314 <br /> CONTRACTOR PHONE: "70 3✓fir&1 r-03 y`/ CONTRACTOR EMAIL: Scar kr ces 5g c,e 0)c ler, ca <br /> CONTRACTOR LICENSE#(REQUIRED): PL.l)M(\c S C CITY OF EVERETT BUSINESS LICENSE#(REQUIRED <br /> PRIMARY CONTACT: 0 OWNER XCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 51ia(,jy Corer CONTACT PHONE: "703_)8 i._ g,'-I/ r <br /> CONTACT EMAIL: 5(,ar ier& ScW,1 , 4041 <br /> BUILDING PERMIT APPLICATION , <br /> Existing Use of Building: Contract Price of Work:$ AMMO fa. CS <br /> Proposed Use of Building: Heat Source: ❑Gas Itiii lectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex Multi-Family-#of Units: ❑Commercial El industrial <br /> Type of Project: ❑New ❑Addition ❑RemodelRelpair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: &et( oee p I�f dtt IN pa'IG(oIc j4,Ax (,.,e5 cJ pcerx <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 a\ Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 3.‘-\ Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration 046. Shower Floor Drain <br /> Gas Fireplace Wood Stove \`j 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: _ 90`kIbS <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/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 I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the, tate Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> �• � PER k E64—00q-- <br /> �• ."-er/Aut••riz.- .en Igna ure Dat PER <br /> 9/23/2016) <br />