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4-77 PERMIT APPLICATION <br /> BUILDING / =HANICAL/ PLUMBING /SIGN / KLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICE <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 /> (Blue or Black Ink Only.Please) PROJECT SITE INFORMATION N'` "`` ` ' ,, ,, w <br /> PROJECT SITE ADDRESS: a-4n Bok,,, � _EVCrck.k.. .34.366,IOL av' &°tR PROPERTY TAX#: 2$( j 00400 100 <br /> LEGAL for new construction: Short Plat/subdivision %J/J% Lot No. (attach copy of long legal description) <br /> .. ., w F CONTACT INFORMATION ' <br /> OWNER NAME: Mr, V V iY\Sr'Ov- LGA SS't:y TENANT NAME(If Commercial): 'Pg,I.n0,,Y 4. \-( d <br /> • <br /> OWNER MAILING ADDRESS: STREET 105 11 1c1t' !we.. 5E. 5u#c.C.. <br /> CITY .. I- ,cSTATE WP ZIP Q 7�Z�� <br /> OWNER PHONE: 42.6- ?1n Z,CI— 4'k OWNER EMAIL: Wih�j\-cy\.1(�jiGy@o a�l(Ytgik• Corr <br /> CONTRACTOR NAME: T.16,D. c� <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: .,-- <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ® OTHER(Please Specify) Aeon;cer*I Pets o4 .®r <br /> CONTACT NAME: FYtih64 kkO h e.\4,et.1/4`j_. CONTACT PHONE: AZ5-$2'9- -z c o <br /> F)r`4#aNy fnown CONTACT EMAIL: by\ \Aibrow\C,chOQrc\- .Cor- <br /> BUILDING PERMIT APPLICATION s -, n.. <br /> Existing Use of Building: Contract Price of Work:$ 76—Lt"4 l<___, <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ISI Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair I .T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: \\ o( `c.GYv.,odeA(uXN\-c�ktivG tAvz,A) to 1MOCA'c-1 -1..k. ,PSG, For., 5 Ce. 'Orc. <br /> 2.140 st.qt. OVA 5 u.v. ov,I O ccci ce_. W'\-'Irw 1\4koYCr�' y-k-fttnS\el LA4fitnt-` of1 IrPs`.t vv(ti.b, <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 #of #of <br /> List of Fixtures List of Fixtures List of Fixtures Listures <br /> Fixtures Fixtures Fixtures Fixtures t of <br /> A/C-Air Handling Units HeatPymp"' Toilet Backfl reventer(Inside Bldg) <br /> Forced Air Systems i rIit'1ieater Bathtub „...Idr1nal <br /> Gas Piping ''d 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 Dishwasller' Roof Drains <br /> Clothes Dryer..Hookups Other: Clott eg-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 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> bDn6,... 701/1411 CI 177 I l' —' A City of Everett Official Use Only <br /> PERMIT <br /> 01 -OH q <br /> ,....2) <br /> Owner/Authonzed Agent Signatu Date (Revised 9/23/2016) <br /> Oi <br />