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PERMIT APPLICATION <br /> "1111.11 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��` <br /> PROJECT SITE ADDRESS: /0 N Ay,c'dJN ety,E NI-PROPERTY TAX#: a.'g 05-17 00 0/100 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 9 not 141 {c •VI TENANT NAME(If Commercial): SO 11 N y T ep."t yca k <br /> OWNER MAILING ADDRESS: STREET 3t--7b 3 /'t /rJ V 5' /p-f g 142, 2 <br /> cm, Fed ev I VII Ok STATE IN ZIP pcp„? <br /> OWNER PHONE: I OWNER EMAIL: 'f VN I9\/ 4t0oQ C��q I , L-C441 <br /> .iatvr,Im <br /> CONTRACTOR NAME: 1 3 d 7'1 <br /> � 6/444=— P>M Q_ Ccrn5-41-m c"Hincri 1 N l <br /> CONTRACTOR ADDRESS: STREET <br /> --r�,/� yo? k ,4v p <br /> CITY �/,J CO A- STATE � "' ZIP 9(�4-L.� <br /> CONTRACTOR PHONE:— ten n� 4�(j (C�ON�TRACTOR EMAIL; +,ryyti beo Q J 'E ,- ri0j I '(.O ry,i <br /> CONTRACTOR LICENSE#(REQUIRED): 13M A `oCL( 1(3 B M CITY OF EEV_IERETT BUSINESS LICENSE#(REQUIRED): (27,2/?/ <br /> PRIMARY CONTACT: 1:1f - <br /> OWNER 0 CONTRACTOR I THER(Please Specify) 9to(i cok ��i�` e'� <br /> CONTACT NAME: CONTACT PHONE: 10 6 3 ? "1t / <br /> t}- C i v ) CONTACT EMAIL: 3 C' cA e-rim 1 9 YN c f(. 4-‘14.ti, <br /> BUILDING PERMIT APPLICATION (3e. Qv ) MC.? • GO Vie <br /> Existing Use of Building: V S-ft J.A el 4 Contract Price of Work:$ 3O ®0 a <br /> Proposed Use of Building: Iee.51A` Heat Source: ❑Gas DElectric DOther <br /> Building Type: DSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel DRepair LJ I.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: m hJ I^ Ver) 1 V� •1i-�i o 1� r s(/.o 1, I'L, <br /> i� f VvG�,t i die W► /L.1 c� S�i-.k c-f'�, ,..� <br /> �eX�sfT+� ' - '7 a v. KW►a+c v s <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 #of 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 /> 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 SYSTEM <br /> Chemical or Water ' 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 /> PERMIT# <br /> / /V/ -315(( b,ad <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />