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PERMIT APPLICATION <br /> ,/, A BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> AIV CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1.632 WcAnv V ¶ 114 fITZO 1 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: --.1 )('Cr) \ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1/\;3 On S)-- h 0.-410 -/ <br /> CITY SCC- 'C / STATE `V�+{4 ZIP (/�(�`fil01-1 <br /> OWNER PHONE: I(ZS_ 3C-1 , QOM. OWNER EMAIL: k.enreo,L T) <br /> CONTRACTOR NAME: Er& fPd""r nn �f( <br /> CONTRACTOR ADDRESS: STREET 6,2Z-_` f 1 I1 u SV <br /> CITY ,\„..t STATE Ll/4' ZIP A Z <br /> CONTRACTOR PHONE: 20G "WI. SISCONTRACTOR EMAIL: Eike `!'k4 Jw,le_. (OM 4Pr <br /> em otal <br /> p <br /> CONTRACTOR LICENSE# EQUIRED): £11(0`D9?c 61 KS CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �[7U3`-c5 58Z <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: Eck , CONTACT PHONE: _`-)Ig. S"7 <br /> IJ CONTACT EMAIL:ilk ey-kt,efilt Co"-, <br /> BUILDING PERMIT APPLICATION � <br /> Existing Use of Building: Contract Price of Work:$ 3rt/l ()OD <br /> Proposed Use of Building: l feat Source: ❑Gas L(JElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR{kttached ❑Duplex I Vlulti-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change ttof Use <br /> DESCRIPTION OF WORK: g1 4\ X14,. 1.�^c) -/j tii,1dr�S) id() - kIeu v,a - vela. , <br /> v wark wrap” <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPt"CATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn `�/Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #°{ List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump '"7 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 2 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 Hood i_ Water Heater Other: <br /> 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 /> V-\ r � ' r PERMI— �v) I <br /> II <br /> I k COL. <br /> Owner/ uthorized Agent Signature Date (Revised /23/2016) <br /> c.,, <br /> , <br />