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446-77 PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ 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 /> (Blue or Black Ink Only Please) PROJECTpSITE INFORMATION <br /> PROJECT SITE ADDRESS: �5 L.I Z lA OLA ti I \V PROPERTY TAX#: 04111300501300 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION —11)C, <br /> 1 <br /> OWNER NAME: R e(,(l41 t cart �P4i-I-ll u5 L I,,,(, TENANT NAME(If Commercial): 1 1)C, 1::-:\).(C -t- C 11,r "-i c <br /> OWNER MAILING ADDRESS: STREET 3 go/ H-0y4- f i-t a <br /> CITY 'V�f.e{A l STATE IA ZIP 7i 2&) <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: M-e t( c i In �(�/,� (�A,y <br /> CONTRACTOR ADDRESS: 1 STREET 7JO6 1-1'Id�A,I / q9 <br /> 5 <br /> CITY NA 0 /J I-- v fx1rikiA STATE <br /> �k ZiP qua 73 <br /> CONTRACTOR PHONE:3110' 1124 13 a.S !CONTRACTOR EMAIL: Stet-unl C ei IV't.t.ers II 4r - (DA" <br /> CONTRACTOR LICENSE#(REQUIRED):NAE E,gs a 31,-6 CITY OF EVERETT BUSINESS LICENSE#( EQUIRED): <br /> PRIMARY CONTACT: 0 OWNER E$KCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACTJ �(/1.11NAME: CONTACT PHONE: 3(10 -I,)PiX13 as" <br /> - <br /> .1 E ! 1 1 1 r, LitAilqvi CONTACT EMAIL: 5r'C7./flt e.0 M't/i,"e(Sign• co" <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ /L. , v i.'4.1. 00 <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: DSFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: CI New DAddition DRemodel DRepair DT.I. ESign` DSprinkler CI Demolition ❑Change of Use <br /> OF <br /> DESCRIPTION WORK: t h W4 t t%RA Vv o 1 1v uicv\ c 1c(.l�( <br /> � <br /> iT �- 50U-HA f1-euati alio � vU(�1�� S1�(�.$ 6,A <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 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 /> PERM . <br /> 0 r/Authori d Agent ' nature Date (Revised 9/23/2016) <br />