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PERMIT PPLICATIO <br /> jT s BUILDING/MECHANICAL 1 PLUMBING I SIGN 15RINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> Wage or Black Ink Only Please) P'=©JECT SITE INFORMATIO i <br /> PROJECT SITE ADDRESS: f -3e;) CQI,, Ave. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision / Lot No. (attach copy of long legal description) <br /> C!!-NTACT INFOP .,'ATI®Nal — 1 <br /> I <br /> OWNER NAME: /Lp�lfi. 4bu sQ„ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET p %• <br /> CITY UZeie STATE Lem_ <br /> ZIP 26 <br /> j <br /> f OWNER PHONE: OWNER EMAIL: <br /> !CONTRACTOR NAME: IG//v-/ 61e. <br /> 1 CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> I CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> i CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: // CONTACT PHONE: <2 702, 6-54V <br /> 549/f Sdtro f r-� CONTACT EMAIL: 55ecrG- -_e 4I , 'r - <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 1, <br /> (--{ <br /> Proposed Use of Building: - Heat Source: OGas DElectric IhOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached DDuplex ❑Multi-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ✓— <br /> 1 4141114/ fitica1/4244-04' erk. Cfiee 1 65 etre <br /> ekeyt.a, I e.irya, <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 /> 1 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 I No. of Heads <br /> — _ <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 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State .nt-,ors Law 18.27 RCW and 296.200A WAC. <br /> /i City of Everett Official Use Only <br /> ilir7 ��—— — 10 1 ERMIT# � 1�1bP — --- <br /> /_ /1, / l � �_ � i3 <br /> OwnerlAuthori 1 .7, nt Signature ate (Revised 9/23/2016) <br /> Il <br />