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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN /SPRINKLER I DEMOLITION <br /> '4444r4LWI. CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)evvettepsC~rrJ,everettwa.gav I www.everettwa.gav/permits <br /> Iglu*or Black Ink Only P`t.ase) PROJECT SITE INFORMATION <br /> L."SE eVE &T7Tj `I S�LOS PROPERTY TAX#: 003970000#606/P,3 <br /> ' <br /> PROJECT SITE ADDRESS: �} f ) ra <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> As <br /> CONTACT INFORMATION <br /> OWNER NAME: ky ik• 1/EV/A/S TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1"e /45 A-691/6- <br /> CITY STATE ZIP <br /> OWNER PHONE: 'f 2S= -/06 2— OWNER EMAIL Ke'A l ;i.6 P " * f div i <br /> CONTRACTOR NAME (4,404ry f2,579 F R)F/.Vey, Mg, <br /> CONTRACTOR ADDRESS: STREET /7 4 Z La /5-,‘—'*. 1 vEA1u g. se #10h4 �] <br /> / CITY 77,467,...4...- "'STATEZIP "'j o©!/ <br /> 6.... <br /> CONTRACTOR PHONE:T�—'48,-—Q//f CONTRACTOR EMAIL:1/ t5r.yiCo Jt z," •e„pl9M,. ee vi <br /> CONTRACTOR LICENSE*REQUIRED):C ,A1 -„r-0 I Oftl"/ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (2343, <br /> PRIMARY CONTACT: 0 OWNER [W6ONTRACTOR 0 OTHER(Please Specify) <br /> w <br /> CONTACT NAME: CONTACT PHONE: 14 25- 4$5-_01/1 <br /> /<RJsYy -t-loF CONTACT EMAIL: /SrigA ?,fl,E " &R !/ . 614 <br /> Y <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: SFR- Contract Price of Work:$ i-1 1 '2,(7),0r`._........ ............ ...... ..................... <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric DOther_,,. <br /> Building Type: L".Y.sFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units. w ❑Commercial ❑Industrial <br /> Type of Project: ONew DAddition ❑Remodel ❑Re ❑T.I. ©Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK; <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 /> •A/C-Air Handling Units yHeat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler wLavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration _ Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&DisposalGrease 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/Mopietc.4. Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I No.of Heads _ _ <br /> ACKNOWLEDGEMENT:1 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 1 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 /> At <br /> PERM • <br /> /íi/i8/Authorize• ntSig Da (Revised• 32015) <br />