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PERMIT APPLICATIC= <br /> BUILDING/MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> IOSEFT 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:/53 I37 ST' SE PROPERTY TAX#:Z$0 c 3.;:)b<::).46 6 ZotJ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: -77M 1--ifito KJ P)6 TENANT NAME(If Commercial): Li-('Le. VIA --c4 2S <br /> OWNER MAILING ADDRESS: STREET Sc-Cb b E1 teel--1\N {SA `\ <br /> 4a(:s� CITY L) J A - JTATE 3 vim' ZIP <br /> OWNER PHONE: 3(.--6`/-' 6i --v-c-.3. OWNER EMAIL: t•�AIA3K-C l e-- C*M CST t <br /> V <br /> CONTRACTOR NAME: Meip_N 4. sero „,s r',,,/C, ”' ,a11/4) <br /> CONTRACTOR ADDRESS: STREET (t(ZL RA Nt,_A '''boz... <br /> CITY SUI) bril STATE AZ ZIP 8 s--273 <br /> CONTRACTOR PHONE:12b_$ 1.z .,1-(4:,-/-c, CONTRACTOR EMAIL: &9!AV t-to - _4 IA <br /> CONTRACTOR LICENSE#(REQUIRED): 0.46e..H4 1(1 C-z_ CITY OF EVERETT BUSINESS LICENSE#(RE0 IRED): 6 t 2 <br /> PRIMARY CONTACT)WNER ❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT N E: CONTACT PHONE: Jb 6Y�/�r I -.a(� <br /> --170-\ ao� to CONTACT EMAIL o(<J • , `s .art Air k __.7- <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: VA_CA. ) <br /> AContract Price of Wor.,:`• it II_ <br /> Proposed Use of Building: r Heat Source: s Electric ❑• er <br /> p Lot C�`-�RIe.S -Z2.'ZA�c �• <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units. _, ommercial ❑Industrial <br /> Type of Project. ew ❑Addition ❑Remodel ❑Repair DTI. ❑Sign ❑S(p�ri�nkller� ❑Demolition ❑Chang`eofof Use <br /> DESCRIPTION OF WOR D ' r l�-('�.� 0,-MGS►'t Prj- pW S 1 ePt tsi 13c <br /> wP -- A t K 5 �► ' wiggly�wie'!S"S <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 o ixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems it Hea. — Bathtub Urinal <br /> Gas Piping Boiler / .3 Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater v;-'aeration Shower 1 Floor Drain <br /> Gas Fireplace ` ood Stove 1 Kitchen Sink&Disposal 1 Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer-•.. ,;s i Other: Clothes Washer Medical Gas <br /> Range Ho. z. Water Heater Other: <br /> Exhaus: an I 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 an, ..nfirm 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 per t o ly authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized nder any circu r to ce.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 I- " 4.27 RC /an/ 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIj C. (r40(. -- 03 • <br /> ..i C� i? 0 <br /> Owner/Authorized ,-,-nt Signature Da (Revised 9/23/2016) <br />