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PERMIT APPLICATION <br /> 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) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: yC 06-- s� E eA4e77 //jy//4,,�, , PROPERTY TAX#: ppb f^ e a� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 7-198(s'E-% S-Ti?es ` 7 33 9 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /O £OX '2 a Pj aj <br /> CITY /5/ e STATE <br /> �! C <br /> // c:DAr 'l <br /> OWNER PHONE: <br /> `�Sb - i�— 7 3 Ra OWNER EMAIL: /5//aTchc.,�bnJcV/W i/�eS/7.(J C d <br /> CONTRACTOR NAME: J /6-41 /21/*&/- <br /> CONTRACTOR <br /> / //-CONTRACTOR ADDRESS: STREET /57 . / Z)/ <br /> e-A �/e�Gy�v�j��/ Dy� <br /> / <br /> CITY r/O/,�,f / !// .2/) STATE /t ZIP �tj I2 9 2 <br /> CONTRACTOR PHONE: 3‘o_ fJC;g—tlCONTRACTOR EMAIL: /4A7-4: <br /> CONTRACTOR LICENSE#(REQUIRED): -Y.7.2.9 T 3 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 4A7.1. 9969., <br /> PRIMARY CONTACT: 0 OWNER ®"CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 340 v iz r.2 g_ <br /> a/4 7 CONTACT EMAIL: 7- � r4�Vbh�}/d�7,-(SA/ CO- <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Ae7 /L y Contract Price of Work:$ <br /> Proposed Use of Building: /r Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Iilli'mmercial ❑industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. aS`gn ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: 4-ti $' 4l CC ((> /g5(/;,1/ / /l arylj,t/ip cA,q,V,oet Coy o <br /> TA)L74-6! P � " /A'/'0' oie�e� /'k j- (4-16, �• „u sip4/ <br /> flex ri/NyC /04yL®ni S/4 /=/ex /cces oA) ems:sTi,u� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): S/ 9' Po44-- $'X8�) .`JQx ccs <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 #°f List of Fixtures #°f List of Fixtures #°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 Itchen 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 ' No.of Heads <br /> ACKNOWLEDGEMENT:i have reviewed this application and confirm the information contained herein is true and coned: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.lam the owner,or lam 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 /> PERMIT# <br /> A �,o;.14 <br /> � �i U S——Ott <br /> OwnedAutho zed Agent Signat re ate (Revised 9/23/2016) <br /> i <br />