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PERMIT APPLICATION <br /> /141P,%/—_ BUILDING/MECHANICAL/PLUMBING /SIGN/SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) 1.4 PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: fi 5,3 4;,. 1-),T f o `f`r PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Al IC (19.0PF,`t/ 4f,DA Ica , �. ...0 TENANT NAME(If Commercial): `j 'V- <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: -►itpaG VA- <br /> CONTRACTOR ADDRESS: STREET 5-65-4 S SoS 41- <br /> CITY <br /> ,1CITY 4fttliWANi STATE W ZIP G{g0(9-L <br /> CONTRACTOR PHONE: otlz6- g.2.7_ �2 7,� CONTRACTOR EMAIL: 44-O(tj- po..A.N.1 ® eery,pt1iQ Loy, <br /> CONTRACTOR LICENSE#(REQUIRED):'Hc4SG Sod g A511.5- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 55 f 2- , <br /> PRIMARY CONTACT: 0 OWNER ifiCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: -t{p,,•(fl W3ci'J CONTACT PHONE: 2,c,6 <br /> CONTACT EMAIL: 4CW-6 T ?i}-. j @ 4 ni ) , Cx(71 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ A O 0 <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: gCommercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: kaivvp6o. w9lz_tc 5 m Nb.. F..01 ow QrDi culQ¢, E g <br /> ASSOCIATED BUILDING PERMIT#(if applicable): /3(So-j-053 <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 #°{ 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 g‘ Bathtub Urinal <br /> Gas Piping Boiler 4. 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: I 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 ( 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 /> o <br /> 6IP , \ � <br /> .soy - I '- � ,(� � <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />