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101477PERMIT APPLICATION <br /> 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 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 i®ZR ,;.0.±1._, Du2 SE PROPERTY TAX#:O1 ySW/C/06 600 <br /> LEGAL for new construction: Short Plat/subdivision _ Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: A )(, 9 >.U-6n- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /1 Q aOA Dia. 5 <br /> CITY gtiCee rr STATE (J 14 ZIP ctYr.Q' <br /> OWNER PHONE: Zg--x'76. -0739 OWNER EMAIL: <br /> CONTRACTOR NAME: 9A'Yd-Ahre utme/,u&- (2I--1-16.472A)G. - <br /> CONTRACTOR ADDRESS: STREET /, ( /L/ e3.„ A 14.(p r J. <br /> CITY Z--W A)(A)(X)1:7 •STATE ( CJ4 ZIP 9 VO3 7 <br /> CONTRACTOR PHONE: L-/ ,-775-6,144 CONTRACTOR EMAIL: tie.'/ J�t'A-JDN0.6. Ater <br /> CONTRACTOR LICENSE#(REQUIRED):Dfry/V:Fpf-}.9/./Lite4 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): et"?74 <br /> PRIMARY CONTACT: 0 OWNER *1 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: .1+2. .----/-75-6,e -6,4i <br /> 13 oNAT3 e ¢i CONTACT EMAIL: .F/J (2�A+ Ai ,A'�-- <br /> IBUILDING PERMIT APPLICATION <br /> .xisting Use of Building: Contract Price of Work:$___486,7i 00 <br /> Proposed Use of Building: Heat Source: DGas WFlectric DOther <br /> Building Type: ❑SFR-Detached tSFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial (Industrial <br /> Type of Project: ❑New DAddition DRemodel ❑Repair OTT. ❑Sign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: -rte .fir, LL , .1\161,0 {N&j-Lt /-1 x} '" Pct y�p <br /> .�--+� t� DU �-ea-t <br /> GUl77hfe-- ounco 0,- (- 0I r (3ew6-- PLFI-Go 6;,,,i -71-1.e- <br /> ASSOCIATED BUILDING PERMIT�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 #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units J 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 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 /> went 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 /> uiiding 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 ROW and 296.200A WAC. <br /> / City of Everett Official Use Only <br /> PERMIT#�/1 f ,C/� <br /> Owner//horized Agent Signature I(0 . 6-4 /I <br /> 6/ akeV (Revised 9/23/2016) <br /> 1 1 <br />