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PERMIT APPLICATION <br /> '111111 BUILDING/MECHANICAL/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: 2.6 O2 L j) PROPERTY TAX#: f?6 437 /, 7OZ/AO <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 15 t� peat cg...6:/tW rtNANT NAME(If Commercial): ,41-. 0 <br /> OWNER MAILING ADDRESS: STREET igo Z. .41-ICE/6-.5;4 AI f4J4- , riOeifeCe#Fre t}4- <br /> CnY g.{k ;77 STATE (4,4 ZIP ei:6005 <br /> OWNER PHONE: et-2.G -7A /j k., OWNER EMAIL: ' <br /> CONTRACTOR NAME: //A /)j (4,L s GI7U4l <br /> CONTRACTOR ADDRESS: STREET 471 g ( 6 L.„0:0 j--1Aij .) „o( i/E � y) <br /> CITY V U� � ( <br /> � <br /> - STATE lfi! - ZIP 'i?b 3 <br /> CONTRACTOR PHONE: 5- 3+3'-gOsc CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): 34 41,6-c--_..C4 59 0 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):cv/5! <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR MOTHER(Please Speci•fy) /���C_,C [ � ( j <br /> CONN-TyA�CTT NAME: s�e � 'tPjcr, CONTACT PHONE: 36"6-,- ' -77 t cohl ,/ N1� <br /> /A /a/t Ogs-k5 ' f //J 7c CONTACT EMAIL: ` yL-The_J7 Si 6,Ai f,e F ./w, cO '! <br /> BUILDING PERMIT APPLICATION t" <br /> Existing Use of Building: '77Z-//1)/ ' ( ( (,(, G.C. Contract Price of Work:$ 4(UbltOD.°' <br /> Proposed Use of Building: el: IL 0j) Heat Source: FiGas ❑Electric CI Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached . ❑Duplex ❑Multi-Family#of Units: 0Commercial ❑Industrial _ <br /> Type of Project: ❑New ❑Addition ❑Remodel El Repair T.I. Cl Sign ❑Sprinkler CI Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 72i0 (FS 100 k;-ST (LC u(z z.A (i)4-LLS "am <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 FireplaceWood 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 /> Number 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 /> Bulldinfficial 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 /> azg <br /> o p with the -tate Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT A <br /> q/19/6/0- i .F.Ifiriflial=MLR - <br /> O uthorized Agent Si. . . ate (Revised 5/ •12016) <br /> 1 (101/ --006 q:.\\- <br />