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PERMIT APPLICATIO 1 k <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN INKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> Ign- 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: 5C-tD L{' S- 'U/E' )' ROPERTY TAX#: tEt6 00 S00-5-000. 0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: h(41"(e4--) v ° TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ,5('(,QLj S. N'`-'+ <br /> CITY STATE `)A--,L ZIP hg 3 <br /> OWNER PHONE: OWNER EMAIL: 1VV/ <br /> Sk <br /> CONTRACTOR NAME: 04„ <br /> J a � <br /> CONTRACTOR ADDRESS: STREET S <br /> CITY STATE ZIP � <br /> CONTRACTOR PHONE([t)3 j�?3DZ CONTRACTOR EMAIL: S r'k 2 7UY`��*�,eA 'Lev"' <br /> CONTRACTOR LICENSE#(REQUIRED): Owe- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):l/' - 'f <br /> PRIMARY CONTACT: )JWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTA NA E: / CONTACT PHONE: 0436 -35'5"- `-7-7S0(2--- <br /> CONTACT <br /> - -3jCONTACT EMAIL: 8,'1 f'_ ,L.t eka.c. [Z @ ii-vrImr..u v' <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: r Contract Price of Work:$ 51)LtOD <br /> Proposed Use of B ilding: � , ,1 W DivitoVrt" Heat Source: ❑Gaslectric ❑Other <br /> Building Type: SFR-Detached ■ FR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New fr-1 ddition ❑Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> D ►'R,PTION F WOR g (,h7 `R V-4-4"-- <br /> p� et° rzr <br /> �YUvw1L, , r —s /�lotMA�- p x I <br /> „,„,,,,-) c,,, <br /> ASSOCIATED BUILDING PERMIT#(if applica e): Oh '�, o ' , aIA(1no. $9 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION btlte, <br /> Type of Project: _New_ Addn _Alteration Repair Type of Project:?New _Addn _Alteration _Repair 11.0/4,1,-- <br /> # <br /> , .— <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 2 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 1_ Bathtub Urinal <br /> Gas Piping Boiler 2 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 j Other: .e/f4/bl� Nue <br /> 400.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 Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 6-- H '—elOti . PERMIT# <br /> er/Authorized Agent ignature Date (Revised 9/23/2016) <br />