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PERMIT APPLICATIOi <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 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 G <br /> PROJECT SITE ADDRESS:aSZS" Evavo cs6�J AA)4 t PROPERTY TAX#:2944 136010 3 900 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) a <br /> CONTACT�IINFORMATION r� <br /> OWNER NAME:144,411/814ti LDts�D ZI II etV'1+11 1ANT NAME'(IffCC+ommerciaH: �Krc4L1 /` JA}b <br /> OWNER MAILING ADDRESS: STREET 32 S 39 �� 9i,y'771-11 �L. r7 w q//\.� J� <br /> CITY Q(r; -Lr �.�,r/�trl STATE WA /'* ZIIP �FO2 3 <br /> OWNER PHONE: 2 S 3 -7( 1 — 64 6I OWNER/EMAIL: 4 t,p�d�c �tx e.t sb i /Je <br /> CONTRACTOR NAME: ilk, hi L !,C <br /> CONTRACTOR ADDRESS: STREET 325 (/V,c6-1. t/v C r7,/J �, ( p, 5'41 a T ''`f <br /> ` _ (Ai/ 7 ZIP �' a0 3 (,J <br /> /� CITY �) STATE ..-}- <br /> CONTRACTOR PHONE: 'Z4 3 i 1 �'Q ZZ CONT GTOR EMAIL: itivieS T3" l/ <br /> CONTRACTOR LICENSE#(REQUIRED):W$ IA I.LK 1'y) ins CITY OF EVERETT BUSINESS LICENSE#(REQ !RED):tedi 7p_ 1 <br /> PRIMARY CONTACT: 0 OWNER eh CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: , <br /> �� CONTACT PHONE: . ,d 6 A -�-►yg^l,_ Z 2 <br /> -..r i 1" • 4,- Ci I '�J CONTACT EMAIL: � Mes 5 v.r 3 ai mh/G. 43 A'{. <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Pro osed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair CIT.!. ❑Sign ❑Sprinkler 'Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 56, G , ii' 'a eG.r,/ry <br /> cpe7to) (7 <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 #of #of #of I <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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 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 C. tractors Law 18.27 RCW and 296.200,4 WAC. <br /> City of Everett Official Use Only <br /> r -) , /� ,-a> PERMIT#�l SO3-- 007 <br /> Owner/Authoriz:. Age Sign ture Date(o �- l/ v//� (Revised 9/23/2016) <br /> 0 <br />