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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 f FAX 425-257-8857 (E)everetteps@everettwa.gov( www.everettwa.gov/permits <br /> (Blue or Black Ink®.nly.Please) . PROJECT SITE INFORMATION • • . <br /> PROJECT SITE ADDRESS: /11-0 15`41 c PROPERTY TAX#: 2.130 Y-1606/0(200 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> • <br /> • .CONTACT.INFORMATION . . . ' . .. . . <br /> • <br /> OWNER NAME: Wilda.- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /77 <br /> 0�..+�7 9l ' �1,n <br /> CITY ' ! 1 STATE Wif ZIP q '?t? 3 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: C UQG( IJ 5Z'!A-T( Safi.fEET j tt[A-c <br /> CONTRACTOR ADDRESS: STREET 21'2-0 1 l ft-C- AU 0- <br /> • <br /> ccnY t✓vevitsT STATE (V — ZIP i szO( <br /> CONTRACTOR PHONE: 4`ZS•2-52.../3//C.F . CONTRACTOR EMAIL: ?reit, e sr w4 .0- <br /> CONTRACTOR LICENSE#(REQUIRED): C(,G(2.6„Ss®2 G0 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): W 6-7 cc • <br /> PRIMARY CONTACT: 0 OWNER (�9.CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: /1 CONTACT PHONE: C�'2 5_2-5-2-,//C� <br /> ofra /q(f CONTACT EMAIL: A 1, & •5.5/1/ <br /> • BUILDING PERMIT APPLICATION . .•. . . . . <br /> Existing Use of Building: /O_c444(0-6ei I Contract Price of Work:$ 7,5-CO <br /> Proposed Use of Building: Heat Source: Ig.Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial @Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Mo�s�a�b <br /> 6,4„5 -frotAI,-6 / 's+ni Apo- 714-002 cie <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 #°f 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 /> 3 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 BYBTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:/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 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 /> PERMIT 171/1 S <br /> WI <br /> Authorized Agent Signature ate (Revised 5/20/2016) <br />