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• PERMIT APPI..IC.ATIOM DUILDINI II IIII ECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION CITY OF EVERETT PERMIT SERVICES aM� 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or ::lack Ink.Onily Please) PROJECT SITE INFORMATION ' . • PROJECT SITE ADDRESS: aLIt5—UM'51. ' vicer. '�,Nil '3 gia I PROPERTY TAX#:29'0, "-+OO ice"r 0 0 LEGAL for new construction: Short Plat/subdivision 11" Lot No. (attach copy of long legal description) 4110 • TACT INFORMATION OWNER NAME: -1,-;,'c( pri-A-Mbe .. 4SSrar?- ' 5, LL -\-C. TENANT NAME(If Commercial): 4Q t elf, A, ' . OWNER MAILING ADDRESS: STREET €.2.501 ttQ/ G 10 ,r t. I*. - — CITY e E``.u""-{!//(G 6 STATE 1-0,41- ZIP 41Y 1955 OWNER PHONE: -'U2.5-2.52.—69541 OWNER EMAIL: C„w°url�Gc,1:.,e, 5.ker^r(<:,,1u2S5a0..P�:Op-r t CONTRACTOR NAME:Sa12.V?P�c: ' N , E\$G--. T1 it-$ILS; Si e-VL-Ps/ 04,Dhi RSC v CONTRACTOR ADDRESS: STREET 1 Z S "'Sic b-- S t b. gc i CITY Ci4 01-1' rv't I S Y R STATE L-2 A ZIP q22..1, '- CONTRACTOR PHONE: L42-5-So --55jc 5 CONTRACTOR EMAIL:3` 0_exiS r°°-''Se-r'uPr�--NiLd 1'`' r=ri" CONTRACTOR LICENSE#(REQUIRED):GG RN(DES f3--I Kt, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):f gal 85 PRIMARY CONTACT: ❑OWNER )'CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: "125 — ° 65° S J e: j " ct 't.SD r\ CONTACT EMAIL: Se,r-ev\5z.A a a"V e tae. -d'P 4roITL.,e',a en BUILDING PERMIT 1 APPLICATION _ Existing Use of Building: Ccswt•wnafe.: k. II( -;- tr•-i k,y Contract Price of Work:$ `'�o 0,,OOCAr" i J Proposed Use of Building: .W . 61.5 a_0041e... Heat Source: ❑Gas Electric ❑O er Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex Multi-Family-#of Units: ASC mercial ❑Industrial Type of Project: ❑New ❑Addition ❑RemodelRepair ❑T.I. ❑Sign ❑Sprinkler 0 Demolition ❑Change of Use DESCRIPTION OF WORK: zekCCI. r` G.(�� ''� '�xAunz1 i g`„4O�,ca., FC I�" tfi - S e No ' -? itci 2.„..p,y .J�! ; S`' \e ccety � atgC©�wAev�©S \AVv1brio ---ktk-Re.� r eal , t lt 1-14.0r+s L4vt)rS (tti 66, 64) b7/G1i To � 3 ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION ' PLUMBING.PERMIT APPLICATION Type of Project: _New Addn Alteration _Repair Type of Project: _New Addn Alteration, _Repair #of List of Fixtures #of List o ixtures #°f List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixt --s NC-Air Handling Units --t Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal • Gas Piping Boiler Lavatory(Wash Basin Drinking Fountain - Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink& P sposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hoo ps Other: Clothes :sher Medical Gas Range Hood Water.-ater Other: Exhaust Fa Sin ervice/Bar/Mop/etc.) Other: SPRINKLER/SUPPRESSION SYSTEM Chemical or Water 9 JNo.of Heads I 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 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 Building Official before being authorized under any circumstance.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only 44 a 1/1 ,�. - � PE is � � 02Z , Owner/A`1 thd�ied Agent Signature Date (Revised'9/23/2096) p—'� / ELII /�C/