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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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2432-5- /O7`* Pti41e. 5� ti,19267,WZ-'e'8 PROPERTY TAX#: CM()Is 300 y s-ro <br /> LEGAL for new construction: Short Plat/subdivision. _Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: in/ f, Rob { TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET sAin, /.95Nik. <br /> ''// C IY STATE ZIP <br /> OWNER PHONE: � ,R5-- 7... �i -X7e 402-'Ib OWNER EMAIL: SA/p `57-6/ c' vy^) <br /> CONTRACTOR NAME: 1� moiL t/V the..& <br /> CONTRACTOR ADDRESS: STREEr 171 ^,,,.L/ 4- AvEitve Ser 1410,04 <br /> CITY /30 Vi i e' .. STATE 4/,1 ""' ZIP 4920/2'+ <br /> CONTRACTOR PHONE: 9 ii$5-Q/// CONTRACTOR EMAIL: grts-ry c C 0024-7z✓Y,e i <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT��ysr NAME: � y CONTACT PHONE: Z7/25" a 5"—O/ // <br /> / 415 ff ex-- CONTACT EMAIL: pu 511+/ eapse,Ajb/esri5x„6faCilk,1054,,a , <br /> BUILDING PERMIT APPLICATION `" t <br /> Existing Use of Building: 5,FX Contract Price of Work:$ / 541.G7e? _,,,,"`n=.,_......_ <br /> Posed Use of Budging: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: I$SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units. ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ORefiter ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ©Change of Use <br /> DESCRIPTION OF WORK: <br /> leteno ye_ C L posi[41` L(hc, erx-cpaktwirx. <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 <br /> Fixtures Fixtures List of Fixtures Fixtures List of Fixtures FixturesList of Fixtures <br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> • <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 I 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 WAC. <br /> City of Everett Official Use Only <br /> ' .* '. '''. ''' 57-?"/"://„.k PZI ( OS—CIO <br /> Owner,, uthorized A e Signatur;/ Date (Revised 9/23/2016) <br />