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PERMIT APPLICATION <br /> elPBUILDING/ MECHANICAL C PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> 101111,1-A <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettv✓a.gov I www.everetlwa.govlpermits <br /> (Blue or Black Ink Only Please) PROJECT <br /> iSITE INFORMATION <br /> PROJECT SITE ADDRESS: 2 H 5 tuMlaia Ev°ey-,e't-T 6 \.A 1QQ- PROPERTY TAX#: 005450.01S044-06 <br /> LEGAL for new construction: Short Plat/subdivision ___ Lot No. ... (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:\Stan t, NM.;I+1f. Set 1'f.7. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: E"°k STREET <br /> S�-2,115 <br /> ,t .(5 LLy IpdGt <br /> CITY Liy7r i t STATEA- zi, ct i <br /> OWNER PHONE: +25 `750-9`•'i OWNER EMAIL:,Sfari5 OW,fitZ yvk6 ..Ai. 0-001 <br /> re/1 <br /> CONTRACTOR NAME: i ,o lttttt�6fl5 A-4-I' `, Y1G <br /> (� <br /> D1t <br /> CONTRACTOR ADDRESS: STREET 6 5 1- 9'14.1��1-' <br /> crit i✓Lisi\e-A <br /> STATE A zip 'I%I to 1 <br /> CONTRACTOR PHONE: .1-25 —S41 I —IQ 5 IC) CONTRACTOR EMAIL:G1$ } .€ reery OtutINC5 kct.e. .eon <br /> CONTRACTOR LICENSE#(REQUIRED):8-R,Fal6t-ts —iTb CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): t/1 n�LJ��`DLF_r <br /> PRIMARY CONTACT: 0 OWNER %CONTRACTOR 0 OTHER(Please Specify) �S� -- <br /> CONTACTj) NAME: CONTACT PHONE: 2,53-331-7235 <br /> ts. x.r4 ' CONTACT EMAIL: N.QY-c.nr e,sret- O1U'b1`OVS C..t or4 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 5 FR, Contract Price of Work:$ 555 t-31 <br /> Proposed Use of Building: 1 Heat Source: OGas DElectric DOther <br /> Building Type: SFR-Detached DSFR-Attached 0 Duplex DMulti-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: [P'New ❑Addition ❑Remodel DRepair DT.I. ❑Sign DSprinkler DDemt�ttabh ©Change of Use <br /> DESCRIPTION OF WORK:c+tib Otit- a iPep, 1AP-cwt. 24- 1: 1-1A, Ja.u2...4-1-sS <br /> , <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: \ New Addn JAlteration Repair Type of Project: _New Addn _Alteration _Repair <br /> #of of <br /> List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures <br /> List of Fixtures <br /> Fixtures Fixtures Fixtures <br /> AiC—Air Handling Units I 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/Mopfetc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Chemical or Water 1 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 I comply with the State Contractors Law 18.27 ROW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> fl,_ l ) \ - PE 11 g\ 0 - 00 <br /> tAudA f <br /> 0 nertAutho d gent Signature Date (Revised 912312018) <br />