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01,4t7r— PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING I SIGN/SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( 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: /2 c /1/2-1-h _s f S PROPERTY TAX#:2806711(0030"-: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) . <br /> CONTACT INFORMATION <br /> OWNER NAME: ifAoirAr s/tQ//Osd is (2) TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /6 9(.�, }y ,WK ft, gro/0 C) kik <br /> e d <br /> 61:0V) <br /> CITY Ly Nr�tx>.t� III STATE R/A ZIP 78C)3 7 <br /> OWNER PHONE: 4q 144�j- _OWNER EMAIL: Cile5 d 'j,S'[, t palj <br /> CONTRACTOR NAME: •,. $ AS. c*Vokerk, N. <br /> CONTRACTOR ADDRESS: STREET ' <br /> CITY ~ - STATE Zap <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED) P4 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):01 ,73.2,-- <br /> PRIMARY <br /> 73'2-'PRIMARY CONTACT: a OWNER D CONTRACTOR D OTHER(Please Specify) <br /> — <br /> CONTACT NAME:,ME: A CONTACT PHONE: (i ) 6.97 <br /> 14,��, <br /> C C l .,5-a�V CONTACT EMAIL: Cle4.5 0 11L / ç , .Otv <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 3,""'impel fee=1 t Contract Price of Work:$ t'.�/ <br /> Proposed Use of Building: .....-1—_ Heat Source: C,Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ©Multi-Family-#of Units: OCommercial ❑industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair CIT.!, ❑Sign ©Sprinkler *Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> P/,Sas-S / vcWe 4 d ,�» iI/�c.. (' t-t <br /> `lb Witt/-107/401 -fe> # v€d IA-Mr. <br /> ASSOCIATED BUILDING PERMIT#(if applicabieL <br /> ` <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 # List of Fixtures of #°f 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 INo.of Heads <br /> ACKNOWLEDGEMENT..!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!am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the Contractor Law 18.27 RCW and 298.200A WAC. <br /> City of Everett Official Use Only <br /> PERI", q- 01-0Owner/ ori dgent g e (Revised 9/23/2096) <br />