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PEE'MIT • PPLICATIO6— <br /> eill°' BUIL DING I MECHANICAL I PLUMING I SIGN I SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> S M 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 /> I(Mase or �1ack lark Only Please) P^OJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 43/4 �9 ll'� f€4— 'PROPERTY TAX#: 00 4 37-eondgt <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATI•N <br /> OWNER NAME: .1ft-vvt L LAA, Re(jo✓ f on- ENAf AME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET a ( 4 r <br /> crrY ��(� VVVbbb vq. / ,�/lye- W c ( STATE (y— _ ZIP get;-0l <br /> OWNER PHONE: - Q� O..fC G OWNER EMAIL: kraLC"V ca"-K.7`!�� , ('014-"- <br /> CONTRACTOR NAME: P-edv0 Lb ova( <br /> CONTRACTOR ADDRESS: STREET D -a, Ov C /y-e, r'` of /7 ,, 5---------Q m <br /> CITY S e c4 LP STATEtat ZIP�./ J <br /> CONTRACTOR PHONE: �Jr ' VlJ CONTRACTOR EMAIL: "t7 ��t c �( n� ( lk l t (0vA <br /> CONTRACTOR LICENSE#(REQUIRED): u, L f LL g CITY OF EVERETT BUSINESS LICENSE#(REQUIRED1 U1 LL <br /> PRIMARY CONTACT: 12 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) WO\f., reog vb0 A5 <br /> CONTACT NAME: . PnMf$ Wt, HQ/un-n-c CONTACT PHONE: 4,3-- - 9a3 - C�L� <br /> (Axil .)o k®G eirf CONTACT EMAIL: Ike coy- g "F---'"`"'t .. a(,tn_ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: IAO✓& . -__..sr'e Contract Price of W rk•$ 073-/ 000 <br /> Proposed Use of Building: \AO VA.€ 5F-P.._ Heat Source: ras (._ Electri her <br /> Building Type: L SFR-Detached ❑SFR--Attached ❑Duplex ❑Multi-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: @New DAddition l.thxemodel DRepair DT.I. OSign @Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> -r- „„ tnne t.e i/ '"'N K1'{f i•L.Q Vt {o pc- brk€.f C. cQe d ir 00w-e <br /> U`-C,M0 C� - ahv �t`n i ✓bo✓t� viz-F�e r��, -�u,� nc� cam;11 Al <br /> 1,4.i'-c i/Lt V\ ir+O S'ew►v( ✓'000 - %,c5 k'2 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): I <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 /> NC-Air Handling Units . Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas PipingBoiler, Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater �\ IefrigaratiSa} Shower Floor Drain <br /> Gas Fireplace s Wood Stove I Kitchen Sink&Disposal Grease Trap <br /> 1 ' \ r-- --n•- , re.r— Ducting I Dishwasher Roof Drains <br /> lothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> r 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 ' the State Contractors Law 18.27 RCW and 296.200A WA . <br /> City of Everett Official Use Only <br /> it) i Vkl ( r I <br /> zo( .,...004 <br /> Owner/Auth iz d Agent Signature Date/ (Re sed 91/2096) <br /> t <br /> ' <br />