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PERMIT APPLICATION <br /> /111?-//2-4BUILDING/MECHANICAL I PLUMBING/SIGN/SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I 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: '33 . 5w {1(n [ way\! PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): II,h t Oh Vjam< <br /> OWNER MAILING ADDRESS: STREET \ <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: ` <br /> CONTRACTOR NAME: , ,- ft. ,, P `' V!'U 1e <br /> CONTRACTOR ADDRESS: STREET 12U G 3 r,%t r. *t\+ <br /> O ( 9 CITY STATE ` �,r(� ZIP ^� <br /> IAV\�`` ��1�V'fi�C7 \ivjl'� �.LS� <br /> CONTRACTOR PHONE: 3U O —'5 -0-111 CONTRACTOR EMAIL: (X l l VC(1 IN p (it,yVt h�r'- G p n W crAci( <br /> CONTRACTOR LICENSE#(REQUIRED): ALL\/V D 83g- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER IaCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 34(D ---ckr-t <br /> Melt�Sln MCG)1 nn CONTACT EMAIL: oklkUGittokl lVlNVtljI VtC) C0 <br /> BUILDING PERMIT APPLICATION J �r <br /> Existing Use of Building: Contract Price of Work:$ \t ( u' 5 U <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: CitLommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ODemolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> ►3lDLi—d44l R--evv\.o GUS <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 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 l 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 I Other: }C,e eDQ c <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) I Other: (.y\S —hOC <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 <br /> LAN <br /> (� q w ,(� ( Official Use Only <br /> ` N/�X v� 0) g I ( PEQ \jD Vca)C0 <br /> e <br /> " s <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />