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OLTPERMIT 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 I FAX 425-257-8857 I(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1 tj 0(, G.7 d:'irvl,o V PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Df uK e_ Q�� KS TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /10 CO 6-.)efano t c Ave, q <br /> CITY £u' k c_tf- " STATE W�} zip 1 g 2) <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME:/-C-E,©,rd a(o I G He.4 inryeF C `A(r'1,9 <br /> CONTRACTOR ADDRESS: STREET 3s"(S" 9q 6t/v, .j •+ <br /> CITY Lox LC c 51.-ve vt S STATE ['.') ZIP TbS'258 <br /> CONTRACTOR PHONE: 1125"-33'j— " D CONTRACTOR EMAIL:ckoolG( ec(kco oiabietnec'%' yy..I ;AL,Gn, <br /> CONTRACTOR LICENSE#(REQUIRED):4(FO R H `I!D KE CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):0S0 52 2 <br /> PRIMARY CONTACT: 0 OWNER 2 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4{25-35H"814c" <br /> C0c4. 6e yap vl CONTACT EMAIL: .t..,,,c,<.4,aff,,,o• .btcl�eee�Lvt7 o[.,.Pco� .r7,kc,Cc <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: S;ky I, Fir.,;IT Contract Price of Work:$ t 70 0 <br /> Proposed Use of Building: Soh jto ; ges1 A tv`c c Heat Source: 2Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex DMulti-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition KIRemodel DRepair ❑T.I. ❑Sign ❑Sprinkler ODemolition OChange of Use <br /> DESA}CRIPTION OF WORK: <br /> AAdl Ot -Coe-ccc' ex.r C+QS ny M. <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 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 f 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 Official Use Only <br /> PERmiLi # <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />