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4.ferr 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 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 9415 -1171.1 CVereitt/ ►.�.'� /?.'e'- PROPERTY TAX#: 29.051 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (--}S6 14L N Lam-e• itr%17cwTim LL(, TENANT NAME(If Commercial): k-(`,6 <br /> OWNER MAILING ADDRESS: STREET i250I Ali- G. form-PL. - �ZY <br /> CITY 661.LE.y U E STATE Wit ZIP g yoa5 <br /> OWNER PHONE: 1-1.2.5--2-5 L c.5 OWNER EMAIL: <br /> PP t7 r^un3c,cJ��PSht v v ,i ciS50C.Com <br /> CONTRACTOR NAME:` RU O N , EV ERcv/ - -v_EnS i�V�NS/ i�(7N ROE <br /> pOE <br /> CONTRACTOR ADDRESS: STREET ( ( � j! -'Nr� I�V� STl✓ 10 I <br /> CITY STATE AA�� ZIP q22.1 <br /> CONTRACTOR PHONE: 25-�jpq-55,15 CONTRACTOR EMAIL:3sore aAL=S2,rvproe_m uettwa.cnm <br /> CONTRACTOR LICENSE#(REQUIRED): ('<VP(S T1 {Rt) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):Q_r) ,,2 LLS <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: LI25 - 65 9 5 <br /> J t: ( tSDE\ CONTACT EMAIL: 3.St,Fe_hS ,e.se,uere. tio5k. Chen <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Co„nm2 iC i`o-k. (L„ ; Contract Price of Work: $ `/0 O r 0 CQ, <br /> Proposed Use of Building: Sci one_ otS c'bO f..- Heat Source: OGas %Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex (Multi-Family-#of Units: -/7 ,NiCommercial ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel AtRepair ❑T.I. DSign OSprinkler ODemolition OChange of Use <br /> DESCRIPTION OF WORK: eti,Vxce, fe, ,c1pc ► 1� ✓ t� ; wc <br /> a <br /> ✓� S f``Avv` M CMA"esCA-TA1his . ci ty <br /> -4- &Iv, • <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 _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—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 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 RCW and 296.200A WA C. <br /> City of Everett Official Use Only <br /> 4 PER00 1, <br /> Owner/`I th i d Agent Signature Date (Revised 9/23/2016) <br />