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PERMIT APPLICATIC <br /> BUILDING /MECHANICAL/ PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 1014117' 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: le 3 77 (p Are-RS <br /> (i L/.er PROPERTY TAX#: <br /> 1Z- <br /> LEGAL for new construction: Short Plat/subdivision 111 4e- Lptate $ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: /r f y fJ-e C 5~ ,/ct w TENANT NAME(If Commercial): V k v C c+ <br /> OWNER MAILING ADDRESS: STREET // O 0YYY��� 5 ' 4 G ti f J 0 <br /> CITY 77(1 /i-;4 STATE e l� ZIP-7 Cl/0.1 <br /> OWNER PHONE: G 0(p 2.. 14 1^2-0 0 0 OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET 1 f b ccr Cj <br /> CITY SV Z-(C- STATE La ZIP 9 ga DA <br /> CONTRACTOR PHONE: g C( I s("7 CONTRACTOR EMAIL: Ev C -@L)L.E /4 C)L ,Co <br /> CONTRACTOR LICENSE#(REQUIRED):``D tKE SL LS 0 e CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):.3 k ?- <br /> PRIMARY CONTACT: 0 OWNER CI CONTRACTOR DITHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: r2,0 C. C1 <br /> 1/v "1 C° Q CONTACT EMAIL: r I C" 47,D/( I 41 f aria k <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: I(/i fry,u c 4-at uNzr _Contract Price of Work:$ -3(9 O' <br /> Proposed Use of Building: Heat Source: OGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached OSFR-Attached ODuplex ❑Multi-Family-#of Units: liCommercial E Ilndustrial <br /> Type of Project: E 'New OAddition !]Remodel ❑Repair OT./. pign OSprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> 1 e D LA) <br /> 3 - L <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 /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Insideii3ltig) <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 INo.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.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 /> t _ d /� <br /> 4-/f <br /> (A_(2,44 " 2''K.. r� PERMIT# DvOwner/Authorized Agent Signature � Date (Revised 9/23/2016) <br />