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*2 ORIGINA 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 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION �� /�/� <br /> PROJECT SITE ADDRESS: g 11 1-1-141 pi 3/ , I PROPERTY TAX#: /� /I/J 3- /C i ' ..f`'YJ(�4 J <br /> LEGAL for new construction: Short Plat/subdivision t ` (�/ Lot No. (J (attach` copyoflong legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ka(P,w (=Ir.(bbi TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1811 bo bolt) 12I sw <br /> CITY EV,2V 7 STATE W� ZIP qg Oq <br /> OWNER PHONE: �Z- -5735- `5- 5 OZ OWNER EMAIL: Pli�10 CI 11 b,h l fl ` oh(6) CCC, roll <br /> CONTRACTOR NAME Z Le_ F,avI-P I— <br /> CONTRACTOR ADDRESS: STREET I1, -7 i 411i51- 3i,() #1 <br /> CITY Ilitalti t A k T& 'vale TATE A ZIP gmzu <br /> LI25�� -`1 .;) I( l/ la i / <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: e l ` i J{� <br /> CONTRACTOR LICENSE#(REQUIRED): I LUh FFH 33 1 }a CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):05Z7R() <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR 0 OTHER (Please Specify) <br /> CO TACT NAME: CONTACT PHONE: 1,-12b - - I �� <br /> ULont11\1 1 <br /> \ rP CONTACT EMAIL: ' 6 b P / i�l0l J �// <br /> BUILDING PERMIT APPLICATION ,�j�� <br /> Existing Use of Building: Contract Price of Work:$ 57t <br /> Proposed Use of Building: Heat Source: OGas Electric DOther <br /> Building Type: FR-Detach d ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: El New -C]�Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ylk,C ,\,{6,..!4 \ <br /> { 4 \ <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 /> \ . -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 /> Number 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 /> ,d I comply with the Stat Contractors aw 18.27 RCW and 296.200A WAC. <br /> in <br /> I <br /> City of Everett Official Use Only <br /> ) PERMIT# <br /> >1 13610 - 031 <br /> Owner/AT'oll'- d'=gent Signatur 7 / Dat W (Revised 10/12/2015) <br />