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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 41,77 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I 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: '(5' Mc PPROPERTY TAX#: OQ 1 exoe,Q f7 7( 00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: VA(tire, a“,ri n eij TENANT NAME(If Commercial): N (A <br /> OWNER MAILING ADDRESS: STREET I^('O COU--11 <br /> CITY WIC ZCtiVVICL STATE IAA ZIP ` 33 <br /> OWNER PHONE:SQ ct •34 I • 4-a-G 1 � OWNER EMAIL: tot tC9 . (j c c.n r�e_ @o14-4100,12.. m <br /> • Co <br /> CONTRACTOR NAME: &1/s w <br /> `et % I el ( S O t-1--Ce--t T <br /> CONTRACTOR ADDRESS: STREET ?n EOA (a-3-1 <br /> CITY La-rel.A._-7 C3l/\ STATE (/OIA stLJ O <br /> CONTRACTOR PHONE: Vs6 • 4 •(Oe)Sa- CONTRACTOR EMAIL: Putt-1 @rbc rl�cc,4-tIrl cc.5p . <br /> CONTRACTOR LICENSE#(REQUIRED): ec(EJ m1Q(i Gt.2- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Q j A.015 <br /> PRIMARY CONTACT: tgOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: p ({A Contract Price of W. :$ 000. 00 <br /> Proposed Use of Building: 10 <br /> IFI Heat Source: ❑G.,s DElectric ❑O er <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Unit-- ❑C. mercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel DRepair DT.I. ❑Sign ❑Sprinkl- ❑De on ❑Change of Use <br /> DESCRIPTION OF WORK: _ <br /> {Z e s�-✓ p e 9 I--v j - 3 s f-cel L s +o '2" l -(-b (I ow f+SY <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 296.200,4 WAC. <br /> City of Everett Official Use Only <br /> 0(g <br /> PERMr. <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> ll <br /> Z- <br />