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4ffiTPERMIT 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION dl/30 e(aea1e, 0 <br /> PROJECT SITE ADDRESS: ill( 81,leig. -5h/ PROPERTY TAX#:, f <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: CJ4'rl a TENA clone T NAME(If Commercial): ,C a <br /> OWNER MAILING ADDRESS: STREET I 11 1 8-.6'64 5f SYV <br /> CITv F rC STATE 4 ZIP L 12-03 <br /> OWNER PHONE: 2-0 6 • 1401 if /IO�WNNER EMAIL: t.S t 0 561 G f 7i GG •, d e' <br /> ) <br /> CONTRACTOR NAME: & rto <br /> CONTRACTOR ADDRESS <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: -7-:6 (;) • <br /> CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): ace r^e C. 46-f O t CITY OF EVERETT BUSINESS LICENSE#(REQUI D)i;toreit a <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR�fBOTHER(Please Specify) "VG�! ..{ <br /> CONTACT NAME: 1 'c f 5m v` ' % CONTACT PHONE: �f , ,,,�q- <br /> CONTACT EMAIIKS' I l� 54,11"G zO r 01, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: pi / Contract Price of Work:$ (*meet/ <br /> Proposed Use of Building: , /S Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: SiCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair I. ❑Sign ❑Sprinkler ❑Deem-olition ❑Change of Use,/ fe <br /> DESCRIPTION OF WORK: 44.4/ ,r ,,/i1 I�f G�Ni e '#IG( ext,f /Vf'C t� i <br /> 17 ti a�f4Gcn1 13t't ldt111 (screw 5M (Vs 5f re/t t exccf Met-toot( <br /> ai< <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 - -pair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of ist of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump Toilet :-ckflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit eater Bathtub Urinal <br /> Gas Piping iter Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Dis••sal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Ho ups Other: Clothes W-. er Medical Gas <br /> Range Hood Water .-ater Other: <br /> Exhaust F Sin. ervice/Bar/Mop/etc.) Other: <br /> SP KLER/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 /> 'IIIIIlll 0AZIN J I/4 Ai PERM!�#� tr9 ,.....0 Li <br /> O <br /> Owne ,ut orizeli Agent Signature Date (Revised 9/23/2016) <br /> 1 <br /> 1 <br />