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PERMIT APPLICATA! <br /> BUILDING/MECHANICAL/PLUMBING I SIGN/SPRINKLER I DEMOLITION <br /> (iiij:677. CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 j(E)everetteps@everettwa.gov I www.everettwa.gov/permits • <br /> (Flue®r Black Ink Only_Please) . PROJECT SITE INFORMATION • . <br /> PROJECT SiTE ADDRESS: 2-2-11 L1/t5T t N 0 MO PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> • <br /> CONTACT.iNP®RM�ITI®N <br /> OWNER NAME: �-e 'S L-4c JYL_ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Q17M r-/3 4pj �j6ue) ('f Li I /A <br /> CITY `,, lial , r , Wit L 8`.0 y STATEAZIP <br /> OWNER PHONE: OWNER EMAIL: C^AU$kill e ��.54 , <br /> CONTRACTOR NAME: C U C.K.C702.66/0 67-WPC I/14, rc. <br /> CONTRACTOR ADDRESS: STREET 2-I 2.-0 Pel ei-C Ac()Or . <br /> ITY lrVYs T STATE W - ZIP EtSZO/ <br /> CONTRACTOR PHONE: 41,5-2_5 2..'3i/4 • CONTRACTOR EMAIL: , /'24 '/e-&4$5''44&id.CAL <br /> CONTRACTOR LICENSE#(REQUIRED): COGY2 ..s 02. ,.. CiTY OF EVERETT BUSINESS LICENSE#(REQUIRED): 9 6-7 q <br /> PRIMARY CONTACT: 0 OWNER RCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NA . CONTACT PHONE: 142 5--2S2 a-5//9 <br /> AKtutS" <br /> s- CONTACT EMAIL: /14Adt&Pe•.f'Mu/,4 -66' _--1__--. <br /> •• •• BUILDING PERMIT APPLICATION • <br /> . . . <br /> • <br /> Existing Use of Building: Ml SC. 44,04.061k.' l Contract Price of Work:$ L7J OOO.. <br /> Proposed Use of Building: Misc. /1,060AP Heat Source: f Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached CISFR-Attached ❑Duplex ❑Multi-Family-##of Units: Ett Commercial ❑Industrial <br /> Type of Project: @New DAddition @Remodel ORe air T.I. OSign @Sprinkler @Demolition ClChange of Use <br /> DESCRIPTION OF WORK: <br /> et-ipct ® cGE ,(4 - div P x f�(( J#ii--t elvc--�les$ pK flevor'a/e- 0aaw k /VZ SP.) <br /> P.) <br /> P tU +t eK 5 4u- Lig S A-C-E a P <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> .1 ' .MECHANICAL PERIIMIITAPPLIC.ATIONol . . 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 #°f List of Fixtures #°{ List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units ? k 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 /> • <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 /> &in:161KLlEIi% fl.i1OPREWIN.I syATEivii . <br /> Number of Heads _ _ <br /> ACKNOWLEDGEMENT/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 am authorized by the owner of this properly to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296..200A WAC. <br /> City of Everett Official Use Only <br /> / 1:6 /1/14/17 PERMIT# <br /> (liwierhkuthOriz gent Signature Date (Revised 5/20 2016) <br /> ill 0 p,-6,63,3 \ I <br />