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PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/ PLUMBING I SIGN /SPRINKLER/ DEMOLITION <br /> "11111404114://-74 <br /> CITY OF EVERETT PERMIT SERVICES <br /> #M 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I 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: 2.2O I W ci"io/'f ti-ve_ FV,erG#/f.�A 4$z.(9l PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: rd K yo/1 C i"‹,,x r hz,.--c,A TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: S 4?RC,310 i.4 L L. C <br /> CONTRACTOR ADDRESS: STREET f(9 Z7 /0 in ,i.o ,.\/C <br /> CITY g fi'y 6 f- STATE tC/il ZIP i g Z 19 ( <br /> CONTRACTOR PHONE: 1--{ 2_S'` 3 (y-et 96 3 CONTRACTOR EMAIL: 3 (Z <br /> P ty✓&c,.( / 0 6 y, ,`I Ce ,NA <br /> �t <br /> CONTRACTOR LICENSE#(REQUIRED): CJ y - (3 9 - Z&7 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): S 7;12_4/ <br /> PRIMARY CONTACT: 0 OWNER 'CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: S 44,4,..,,, J `v <br /> ,, '' ;,,5.v;i CONTACT PHONE: Ly Z5--r j 3 l 96 <br /> CONTACT EMAIL: , P IZt.,v w J '( c)--,,,,,:( co rn <br /> BUILDING PERMIT.APPLICATION <br /> Existing Use of Building: a c.,-(l. Contract Price of Work:$ 15--U00.61) <br /> Proposed Use of Building: 64Lt-C Heat Source: ❑Gas ❑Electric��// ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: L�JCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition RtRemodel ❑Repair ErT.I. ❑Sign ❑Sprinkler I 'Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> PI OV \ (o&/'lc U,,allc dop-^5'47/5 / © Pe•^ u 1) err,S4,1 i r p.-Ay <br /> yr <br /> 9 56-0 a',Li- <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 Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units 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 /> 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.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 with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> t=c6 2? .?0ef <br /> PERMIT <br /> 19)M— 01,0 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />