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PERMIT APPLICATIOIV <br /> BUILDING / MECHANICAL I PLUMBING I SIGN I 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 (E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 267+ 3)5157 ,Su✓ 6\f°r 11et1 PROPERTY TAX#:oosGervvo , <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: r✓9I,A 41'ZU K47(Tvt....avwS(..1' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2-'St G(.- S1 ' S1 S w <br /> CITY ev't -,cli STATE ‘,JV u` ZIP C( <br /> OWNER PHONE: 4-2,5 d tE-- X24-5 OWNER EMAIL:e eCILA)C.ICAN.,i6.7 <br /> CONTRACTOR NAME: ( )() c(U (} N 4J Yj-IONS <br /> CONTRACTOR ADDRESS: • STREET Q s-&'S '3�:N.r' � <br /> ( r✓� /� <br /> CITY 70��^W v L- �} eisc- t j(�/� STATE \ ZIP (kg \ 6 <br /> CONTRACTOR PHONE: 206 3� �(� CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): (ti JO V FS e-Ca t,s ` CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): o91 7 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: zakvk —( , CONTACT PHONE: 2,06 53s- 2 <br /> 1 7 CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 5�� Contract Price of Work:$ 1, *Vet) <br /> Proposed Use of Building: S k- Heat Source: !as 12Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex 0Multi-Family4 of Units: ❑Commercial ❑Industrial <br /> Type of Project: Cl New DAddition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: y COC v\e)(- o �j � �.e`_ u <br /> Y� clv�c�n `� 6u ( h �F' � <br /> • <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 /> #ofList 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(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 No. of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this a.plication, 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 gr -r g of-,Amit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorize.-i er an'rcumstance.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 Contras%maw •; -,W and 296.200A WAC. <br /> / / City of Everett Official Use Only <br /> ,/moi PERMI <br /> � 741'1(7 <br /> Owner/Authorized Agent Signature Date (Revise /23/2016) <br />