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OLTPERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER I 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: q:►Oa"b 2.3� `)i- 1/.1E61 PROPERTY TAX#: 'LS 0 LI 0 7.0 0-60 0$O 0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ' ):\,/ 5 LE( TENANT NAME(If Commercial) V2:1 ) <br /> OWNER MAILING ADDRESS: STREET J 0 0 'J Z3 w'D 'D\2 VCE.- 2d 0 <br /> CITY 'N • " " STATE VIA ZIP 9 IsZ O3 <br /> OWNER PHONE: L1 tis- ?j l{q_t}4'9 OWNER EMAIL: 'S ay 6 C v 1 C-i t L A 4 . o lz-(1 <br /> CONTRACTOR NAME: , ..ycLeAre., t <br /> CONTRACTOR ADDRESS: STREET ,-2e6).0 o v6 <br /> CITYalefaitSTATE CkW 20 k. ZIP - <br /> CONTRACTOR PHONE: . ZS LaePt 0400 EMAIL: `ft ' O p.{ ktt, 4c-- <br /> CONTRACTOR LICENSE#(REQUIRED): `(' -c....ct ( QlepF EVERETT BUSINESS LICENSE#(REQUIRED): CJ"l (p <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:X 4 1-5--2 5-1 -l31 (p t <br /> 4 �IrNI,� &...,‘.\,,i\){?___ CONTACTEMAIL:4 1Lat-it.e_6 c d 4t,�r,•vtel . etel- <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ DI (()00 .tti <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> A 1- 1i AVO\noA 0 - o Ff \C,f-- 54eAcg <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 FL. <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units Heat Pump Toilet Ba . - 'reventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub rinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink& i .osal Grease Trap <br /> Gas Range Ducting Dishwashe Roof Drains <br /> Clothes Dryer okups Other: Clothes rasher Medical Gas <br /> Range Hoo Wa - Heater Other: <br /> Exhaust n ' k(Service/Bar/Mop/etc.) Other: <br /> SP NKLER 1 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 befor1 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 wi t •State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> Al PERnIcK <br /> © I . 0 IlOwe Authorized Agent Signature Date (Revised 9/2 /2016) A) <br />