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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> 001477 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: Lke 111 5 Vi e _o D r, P. <br /> PROPERTY TAX#: <br /> LEGAL for new construction: Short PlatisuPoivision <br /> Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME ��lj e .. <br /> TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1 q �#es— -- V� �o r + <br /> ,___r , l y [(� Z P'."� i�►F - <br /> STATE j-�'" <br /> OWNER PHONE: �—"'"_"�" <br /> OWNER EMAiL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET Li- y-otic►, x,,, <br /> CITY <br /> STATE WA- LIP t S 1,,,_„(-J <br /> CONTRACTOR PHONE:�- 35 R,ic 055-0 CONTRACTOR EMAIL: t vt <br /> �r C'"` i . " C'I�'YI h�'C•�.��'! � 'CSS 4.r"i <br /> CONTRACTOR LICENSE#(RFOLPIRE0): Cmh-eci.i'yLi D"]"Zd I'l CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 1 COCP(4 <br /> PRIMARY CONTACT: 0 OWNER kli CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: -7 <br /> 2."'Z'').' <br /> j CONTACT PHONE: L1. aS9 ccxz, �� <br /> �4 � CONTACT EMAIL: dejo ti(e., p cm Yte(oli"►C •to m <br /> BUILDING-PERMIT APPLICATION <br /> Exlstin Use of Building; Contract <br /> Price of Work:$ <br /> Proposed Use of Building: Heat Source' Aas ❑Electric ❑Other <br /> Building Type ijitSFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units' <br /> ❑Commercial ❑Industrial <br /> Typo of Project: DNew ❑Addition ❑Remodel ❑Repair ❑T,I. ❑Sign ❑Sprinklor ODemolition DChange of Use <br /> DESCRIPTION OF WORK: t <br /> _fu <br /> '4�es r <br /> ASSOCIATED BUILDING PERMIT#(if epplioable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of New Project:Pro � • <br /> j Addn Alteration _Repair Type of Project: New Addn Alteration _Repair <br /> List of Fixtures #of #of #of <br /> List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures <br /> Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump Toilet <br /> Unit Heater Backflow Preventer(inside Bldyj <br /> Forced Air Systems <br /> Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin <br /> Water Heater r Floor Fountain <br /> Refrigeration Shower Floor Drain <br /> Gas <br /> Gas Ranee FirlCe Wood Stove Kitchen Sink& Disposal Grease Trap <br /> Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer <br /> Range Hood Medical Gas <br /> Exhaust Fan Water Heater Other: <br /> Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> [Chemical or Water I INo.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(his 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 /> Oily of Everett Official Use Only <br /> 10 . 17.17 I � I,/PERMIT# '0 0�� <br /> c^y <br /> "Owne lAuthorizod Agan fgnature ✓ <br /> Dale (Ruised123,278) <br />