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PERMIT APPLICATION <br />14.7BUILDING= ECHANICAL/ PLUMBING /SIGN RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIC=S <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: 6 ao 1 ja1 S (. #3 75 PROPERTY TAX#:Q130 I c/00a0dt500 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: LAGO OE PLATA V)LLA L.L•C. TENANT NAME(If Commercial): MODEL HOME <br /> OWNER MAILING ADDRESS: STREET 7416 SE. a%t-ST SUITE a(3 <br /> cm' MERCER ISLAND STATE I:UAo ZIP 98040 <br /> OWNER PHONE: 11,1 W. (H) ' T4da OWNER EMAIL: JV 1-1 E@ PATI NAHLALtEsTATL.COM <br /> CONTRACTOR NAME: CA ARA NCO CONS TROCTIOk <br /> CONTRACTOR ADDRESS: STREET Sc1rf�1 10u`rQ 21'-/c.e. cSZU. t W I� B_ <br /> cu- TT1.I. STATE A. ZIP 9819(0 <br /> CONTRACTOR PHONE: o10G'4 la• 060) CONTRACTOR EMAIL: C KCA IR RANCOQGMatit-CCDM <br /> CONTRACTOR LICENSE#(REQUIRED): CA R RAc.#OGG CI' CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (13:\ 1U <br /> PRIMARY CONTACT: D OWNER h CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAM0 <br /> E: n CONTACT PHONE: 441Q• 06®1 <br /> GE AGE , CAR JANCO CONTACT EMAIL: <br /> C.KG A ilil,ANCD IviAlL.CoM <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$e200 000( 1.101'1a 6O,1000) <br /> Proposed Use of Building: Heat Source: ❑Gas Electric ❑Other <br /> Building Type: , SFR-Detached ❑SFR-Attached ❑Duplex @Multi-Family-#of Units: @Commercial @Industrial _ <br /> Type of Project: orNew ❑Addition ❑Remodel @Repair DT.I. @Sign @Sprinkler @Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1N STALL A `NEW MAN1.)ACTOIIED HOMO IN AN Exl5TING <br /> MANUFACTCRL=D HOME PARK, <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 #of <br /> Fixtures List of Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> 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 /> 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 /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> � n <br /> City of Everett Official Use Only <br /> C� 6&("gor /.O--'' PERMIT# 0�` f� D) <br /> f mer/Authoriz Agent Signature Date (Revised 5/20/2016) <br />