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111111 <br /> PERMIT 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 : 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: Q/ Q`7't‘t Si 5C PROPERTY TAX#: <br /> LEGAL for new construction. Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: j nj .re c...101ab„ 1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 913 gt ..'F+-t SSI oC <br /> 1ry�f,j2 • C . - STATE ZIP g820g <br /> OWNER PHONE: 772 9505 OWNER EMAIL: <br /> �} <br /> CONTRACTOR NAME: C.,1 `/}f C o "� t rt6- <br /> - <br /> CONTRACTOR ADDRESS: STREET 1L416 BYbad / {��{- /� I <br /> Ctm' e STATE <br /> �AWA- ZIP 7?2-4,✓1 <br /> CONTRACTOR PHONE:L 5 Q5 CONTRACTOR EMAIL: d e,A L�.Ji 1r:. t'L'> k eceriete ° COyvi <br /> CONTRACTOR LICENSE#(REQUIRED): cm Cnivi-ect mktS 71411 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): I(Oleq <br /> PRIMARY CONTACT: 0 OWNER qf CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Has cc 35 <br /> �I CONTACT EMAIL: dpI/} 1 Q C/(�I'1 Pt 't inn. •Lp nel <br /> BUILDING PERMIT APPLICATION <br /> 1,�r s <br /> Existing Use of Building: Contract Price of Work:$ •t a(IV <br /> Proposed Use of Building: Heat Source: Was ❑Electric ❑Other <br /> Building Type: XSPR.Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commerclal ❑Industrial <br /> ,Type of Project: CI New DAddition DRemodel ❑Repair ❑T.l. ❑Sign ❑Sprinklpr ❑Demolition OChange of Use <br /> a <br /> DESCRIPTION OF WORK: gerlace, n s -Cur in D re, <br /> ASSOCIATED BUILDING PERMIT#(If applicable): <br /> + <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn _Alteration Repair Type of Project: New Addn Alteration _Repair <br /> #of #of <br /> Fixtures List of Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> I 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 HoodWater Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc) Other: <br /> SPRINKLER!SUPPRESSION SYSTEM <br /> Chemical or Water 1 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 taw, The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Suiiding 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 /> h City of Everett Official Use Only <br /> ? .Xll j '' 2•l 7PERCk _ OS <br /> 'Ovine?ebb <br /> thorized Agen ignature Date (Revised 9/23/2018) <br />