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G PERMIT APPLICATION <br /> /1/11PNL <br /> /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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: o ©' \\SM E t\J{6 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: eisdNy oIjJ C,0K L` tV(ZaH TENANT NAME(If Commercial): C A-Lyajm <br /> OWNER MAILING ADDRESS: STREET 15 t CI M avt ts..1 `IG 'R)2 0� <br /> CITY OC --t STATE kik)Pc ZIP qgV t2 <br /> OWNER PHONE: OWNER EMAIL: HJL w PrN`IOt'. Mee Y,ON 1/4..\.,1C• DM <br /> CONTRACTOR NAME: >C(JN GQ <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: TO OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: T 7 O L( TCZQ O 6051,3 CONTACT PHONE: X1-2s_i_n%-c" 4 L <br /> CONTACT EMAIL: -OW_Lt O b etv,)4 MSCI Cis I-1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 101 $4144044.741h-e... <br /> Proposed Use of Building: Heat Source: OGas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industria► <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> LAN e..)to C (SD r\.) 2.1.1 P4-6 Voe. N€&A- L\k&o 2' _t�-tr <br /> UPOPc tL ) rov Lo t-kolte (v SSD <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 ty Toilet Backflow Preventer(Inside Bldg) <br /> ( Forced Air Systems Unit Heater Bathtub 'L Urinal <br /> Gas Piping Boiler Z 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 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 /> City of Everett Official Use Only <br /> PERMIT# <br /> K( Sea 14 o63 <br /> Owner/Aute Agent Signature Date (Revised 9/23/2016) <br /> CIO <br />