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PERMIT APPLICATION <br /> BUILDING l MECHANICAL I PLUMBING I SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> .7'".e 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) n PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 52.2-1 2.33 r{ve (,U evereeft WA.411Z03 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1Y j Ke, VV 4 tc..te Z. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 522! C% ;lye t,/t) q py <br /> CITY1/ �►ti-f- STATE jAjfi ZIP gzv3 <br /> OWNER PHONE: -ZS.577 3+&O OWNER EMAIL: jyitlfC41 4/e .00.11,1CONTRACTOR NAME /-t tfeSp e 3e Htt j 41`• � 5,4,441...,./.��1 ` <br /> CONTRACTOR ADDRESS: STREET g2 3/ 36'k Aye to s,„-.71...e,I <br /> CITY Lt.{h4wool STATE 1.4),1 ZIP 9803�a---,, <br /> CONTRACTOR PHONE: Z06. 6Le-3. /52,5 CONTRACTOR EMAIL: /n�4)Zs-4,4)/5jse/Vr�C. C <br /> CONTRACTOR LICENSE#(REQUIRED):15 7 �E RH g.SO F3 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED);O55 Z1$/ <br /> PRIMARY CONTACT: ❑OWNER ®t CONTRACTOR 0 OTHER(Please Specify) I <br /> CONTACT NAME: Brp�,rC-�e yi T&c.6(&,,,I <br /> CONTACT PHONE: 2.66. 6,17,'? _ is-2...c" <br /> CONTACT EMAIL: In6g21.S�.,„es pt,$'E'i`7vac. CO1vYJ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 7/ /00 <br /> Proposed Use of Building: Heat Source: $Gas ❑Electric DOther <br /> Building Type: SFR-Detached OSFR-Attached ❑Duplex ❑Multi-Family-#of Units: I:Commercial Industrial <br /> Type of Project: I�New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign DSprinkler :Demolition DChange of Use <br /> DESCRIPTION OF WORK:5 rneffe //2-�7e 11 74 <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 #°f List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> J 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 I 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.1 am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and t comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City <br /> tofEverett <br /> Official Use Only <br /> ti 2.p ,0–i g PERMITS ^ \�Q 2 —e <br /> Owner/Author 7 a d Age Si... - - Date 3 I1 <br /> (Revised 9/23!2016) <br />