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PERMIT APPLICATION <br /> 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: l a`g as 8151. ii\/ei PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No, (attach copy of long legal description) <br /> �� CONTACT INFORMATION <br /> OWNER NAME: Pili tarn Sfi�- nov ic., TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET I ati.0 a,- !ty r g <br /> CITY FveifOr STATE k ZIP q t7�( 4(] <br /> OWNER PHONE: (30(S2 - 5 00(1)5 OWNER EMAIL: <br /> CONTRACTOR NAME: ltiSsUm atm(m( - -off Alidevain <br /> CONTRACTOR ADDRESS: STREET 11010 LOMIYAr4 A\le' <br /> CITY V o e ,p <br /> ' STATE " ZIP q`lircp t <br /> CONTRACTOR PHONE:96 630 M11Zd-a' CONTRACTOR EMAIL: Colt e biOSsbirn5pkAi Corn <br /> l <br /> CONTRACTOR LICENSE#(REQUIRED): gi...osSSLO' AA1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): c5-7(Pozi <br /> PRIMARY CONTACT: 0 OWNER [CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: / { CONTACT PHONE: case;-3�0--Li-2a7- <br /> ®\\/ I1 Okela fl CONTACT EMAIL: CI 1,,,e biosi Dirs®,Ur- Lorr <br /> BUILDING PERMIT_APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ °q f2--fi Lill:`,J/ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other_ <br /> Building Type: SFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel DRepair DTI ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: if 0 Kyy qr)4 I_eo Solo( tyJ' ?r,"i <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 iAddn Alteration Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures List of Fixtures <br /> 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.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 298.200A WAG <br /> City of Everett Official Use Only <br /> elk PERMIT#/*1 fi�J, '�I Cfr) 0%I�;IOwner/Authorized Agent Signa Date <br /> (Revised 9t23/2016) <br />