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r PERMIT APPLICATIOF` <br /> �7 BUILDING I MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> - CITY OF EVERETT PERMIT SERVICES <br /> Sr 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everettep @everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE ORMA ON <br /> PROJECT SITE ADDRESS:5 /?-•/($.41 4 Ui, U)4S1 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision 4ot No. _ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ,S'0..w.m Sak,u4AA4t-Ke TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET .5 J7/q-//. ' /- -Ve u... .s/ <br /> CITY €ve 'ft, W4t/ STATE ung., ZIP 9r�OG <br /> OWNER PHONE: "3 - ',Lea-f44y4 OWNER EMAIL: <br /> CONTRACTOR NAME: POL vet tact t3 t oii..,A el" <br /> CONTRACTOR ADDRESS: STREET <br /> �J/,% *�� "�SQ'' itBle, ME_ <br /> CITY P 7/'yS ii GLG STATE 4 ZIP i?g' ''l <br /> CONTRACTOR PHONE: 1 y2.-Z �� CONTRACTOR EMAIL: $Z',Q-`j(�l k ,t)(� <br /> CONTRACTOR LICENSE#(REQUIRED) CITY OF EVERETT BUSINESS LICENSE#(t�RiiEQ -, r4;...,• <br /> PRIMARY CONTACT: ,OWNE 0 CONTRACTOR 0 OTHER(Please Specify) GC 'd/1l/ W C)8 <br /> CONTACT NAME: CONTACT PHONE: f, Ar,J�(Z�—�T7 <br /> Roa JTA'�/SAKA CONTACT EMAIL: A! s T414141st, 6 7!(flL a .. art <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Res 1 ,4-{A,L'Q, Contract Price of Work:$, 42 c:hp . <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached PiDuplex DMulti-Family#of Units: DCommercial ❑Industrial <br /> Type of Project: DNew DAddition DRemodel DRepair DT.I. OSign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: �,[ �7–eA e1 <br /> i 7 pest t.cik –rt 'e. C`e l 1/t, W*u„ rota- 4-?").S5 -A bLO& j Vt <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn Alteration _Reps' Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List Fixtures #of List of Fixtures #°f Lis Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C–Air Handling Units -at Pump Toilet Backf- Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub ,"al <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 Ho. ps Other: Clothes Washer Medical Gas <br /> Range Hood Water Hea , Other: <br /> Exhaust Fa Sink(S- ice/Bar/Mop/etc.) Other: <br /> SPRIN, ER/SUPPRESSION SYSTEM <br /> C -mical or Water I No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the infor .tion 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 properly to perform the work for which application is made, <br /> and I comply with the rf .ctors Law 18.27-CW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> I. �� ...1M.II ...gh........., P IT tgo9 .._. 02___\ <br /> 6 nT/Auth.'ized Aunt•igna, re Dat' (Revised 9/23/2016) <br />