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PE; NT APPUUCATIO�,. <br /> 01111.11'' t;199 A ECHANOCAL/PLUM:NG /SIGN I-- zlNKLER I DEMOLITION <br /> tail 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 /> ( kie or Black Inks my ''lease) PRI�JECT SITE INFiiRM'TION <br /> PROJECT SITE ADDRESS: 30 ,6rfri p PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. _ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> _ <br /> OWNER NAME: Toniv Pi g t N5 TENANT NAME(If Commercial): <br /> jr^ <br /> OWNER MAILING ADDRESS: STREET Ava9 <br /> , p_, 3E <br /> CITY Ev. j2 STATE ZIP 9C� <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: fwirpr iV vT2 6 �Sr tO�"C(`! t c)n. <br /> CONTRACTOR ADDRESS: STI EEr1-3c9i)11LJ i t 7� 13/Jr- .`� "l R �yCITY � STATE " ZIP Q O �j/js <br /> CONTRACTOR PHONE: 6 6 TN (033 0 CONTRACTOR EMAIL: iii ke., Kel ft 1 1, ati . h f r c et M <br /> CONTRACTOR LICENSE#(REQUIRED): Vei -4�O 13 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 11719 <br /> PRIMARY CONTACT: 0 OWNER ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: y c CONTACT PHONE: Re) `7 "'x.33 <br /> Kik 1�Mtki CONTACT EMAIL: r<2o i'atA(ira 45 i/ f a C?/n_ <br /> j j BUILDING PERMIT APPLICATION <br /> Existing Use of Building:Qin,/' i' Y ICI (' yg,, Contract Price of Work:$ 11 d,q5-5,(33 <br /> Proposed Use of Building: 1 ,�' m)ill J14WLQ_ Heat Source: It�Gas ❑Electric El Other <br /> Building Type: L FR-Detache. ❑SFR-Alta hed ❑D lex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition El Remodel epair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> , wry.'• / •• i✓.1' %kl:'F/r.e' f9vir, Ii1� 1.4f•"►u,i ��r`;�1;/&' 1 ' c; <br /> (-idlyl'Q PICPQF2ce�k(, °f /1 ,L ,. ) C��j' ; / ``Ji r <br /> ASSOCIAtED B ILDING RMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New AddnAlteration _Repair Type of Project: _New Addn _Alteration _Repair <br /> #of List of Fixtures #°{ List of Fixtures #°f List of Fixtures #of List of Fixtures <br /> Fixtures 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 /> 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 Contracto Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> �Yl �>�i b o <br /> PEI C:o b I <br /> I I�C.J <br /> r r/Author' ed A ent Si nature Date (Revised 9/23/2096) <br /> 9 9 <br />