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OLT PERMIT APPLICATIO <br /> lk <br /> BUILDING I IRCHANICAL/ PLUMBING /SIGN <br /> INKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 15 02 E e V&P&d r- inaiA WailPROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. I (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): rico(4 Deo])[— <br /> OWNER <br /> OWNER MAILING ADDRESS: STREET 22 39) Lake_poiri2 ori fe, / S'-f2_, 400 <br /> CITYt(Sri /1 r STATE / ZIP g 60[3oOWNER PHONE: q0.1 1-11 •-j1 OWNER EMAIL: .lie, • Sia rzci nS K.+ for and diem an <br /> CONTRACTOR NAME: <br /> -i"` I <br /> CONTRACTOR ADDRESS: EE�rgO 0)77 3 �q�' w <br /> CITYa-tV‘.1*CiN-0Q—% STATE W 4 -ZIPC. 21 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: 0 J 2. D Z Z <br /> CONTRACTOR LICENSE#(REQUIR ). ��*to 8q-3 CITY OF EVERETT BUSINESS LICENSE#(REQUI D): `�._ \! <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR OOTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: g--(rg —(06i 7S5-baC&1 14 t/l 3e sor CONTACT EMAIL: 5).-7 tuis 'sbyi @ C.Qy(-terpnl n`I'-iS• con-, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Ma )3 re_ Contract Price of Work: 1 l2-10 100 0 6,0./ <br /> Proposed Use of Building: [i f'•2 —II o& - Q PCU'1 Heat Source: aS ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: XCommercial ❑Industrial <br /> Type of Project: ONew ❑Addition €emodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler XDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: . r <br /> fi , %�, L 1) <br /> ur-11111 ' . lw WI ' r •• -0' a ' .... cl\VVy\ -1 fiAr. T1 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATIO ( PLUMBING)ERMIT APPLICATION <br /> Typ• of Project: _New _ Addn XAlteration •epair Type of-Project: _New _Addn Alteration _Repair <br /> #o List of Fixtures #of rst of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> 1 4 N Air Handling Units Heat Pump "J Toilet Backflow Preventer(Inside Bldg) <br /> Forced ystems Unit Heater Bathtub 1. Urinal <br /> 'l Gas Piping Boiler 1 Lavatory(Wash Basin) 7 Drinking Fountain <br /> j Water Heater ' Refrigeration Shower - Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher 'L Roof Drains <br /> Clothes D -r Hookups other: Clothes Washer Medical Gas <br /> Range ood IWater Heater Other: <br /> ...iEx►:ust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> • <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Ch Ch ica or W AIL No. Heads <br /> CKNOWL_ GEMENT: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 /> CityofEverett Official Use Only <br /> II44 <br /> \ 1/ " ,0 I i S PERMIT I V 1— O 1 -1al <br /> Owne • thorized A e t Si natur: ` Da (Revised 9/23/2016) <br />