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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN/SPRINKLER/ DEMOLITION <br /> 4477" 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) A PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: IuO5 t�O`tT tw, PROPERTY TAX#: 004 S3'.52-1 3 Oe 3Oc> <br /> LEGAL for new construction: Short Plat/subdivision Lot No.3*4( (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: CD 3r IS GRAi-IAM TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> Crry STATE ZIP <br /> OWNER PHONE: 14 G "42.4 Lf -X177 OWNER EMAIL: <br /> CONTRACTOR NAME: Qt,JA <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 8 OTHER(Please Specify) g ES(-67 NEZ_ <br /> CONTACT NAME:1/30:,x 5L0 tt��p CONTACT PHONE: 2dk,, 4137, c) ‘‘ <br /> CONTACT EMAIL: Ai_s_x C3e `t'r'.Ayi)GS, c.OfrI <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: S 5 (Z � Contract Price of Work:$ 2-4,OCJc') <br /> Proposed Use of Building: 5 -•?.-- Heat Source: ❑Gas ®Electric DOther <br /> Building Type: 51SFR-Detached ❑SFR-Attached El Duplex ❑Multi-Family-#of Units: DCommercial El Industrial <br /> Type of Project: ❑New DAddition C$Remodel ❑Repair ❑T.I. DSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: n (il ,,,,•tN I;ASF.r...m.i... t E. J1OP`-(_ y/i OF !7A56_64, -r, i2.Es..11 sr. <br /> 31,1(f7. T© U )C,, uP -ro c0 9 i <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ,. l '05 -003 <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 I Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater ( Bathtub Urinal <br /> Gas Piping Boiler 1 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 /> I 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.lam the owner,or lam 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 /> ' (0 (V (� PERMIT#{-1 I 9:0 � �wner •,thorized Agent/SiggnatureDate (Revised 9/231/22200711`6) /✓, <br />