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PERMIT APPLICATIOP' <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 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 <_. CX Cc+Pj3'L-ml-Qa1<-Oa-tufo <br /> PROJECT SITE ADDRESS: (Q1GjT ems' ISZo�jPROPERTY TAX#: LX'(.02?j2-co 4 Qt{p-w <br /> LEGAL for new construction: Short Plat/subdivision PAM Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1304,41.0(,V ,l[__ 04000 Aorizano TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET To qZ-( <br /> CITY �J j�t" STATE WAc ZIP 4:167.04, <br /> OWNER PHONE: (. 4. 714-. cc-act OWNER EMAIL: h it(0. <br /> CONTRACTOR NAME: k I, WALIWAILMEn /1 r [A/C , <br /> CONTRACTOR ADDRESS: STREET 1 �� <br /> CITY J STATE ZIP <br /> CONTRACTOR PHONE: ' U09)- ?) (o- CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 'OWNER 0 CONTRACTOR SOTHER(Please Specify) 2 &-41 .,j <br /> CONTACT NAME: CONTACT PHONE: zocc, 5r.s2- <br /> C% %b 1?LIt t CONTACT EMAIL: a.,r, 140 Sc.-. A-Lli‘ •GOYA <br /> BUILDING PERMIT APPLICATION .;. <br /> Existing Use of Building: F'ttJL "r14t Contract Price of Work:$ � COO <br /> Proposed Use of Building: 5A -t . Heat Source: OGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex 1itMulti-Family-#of Units: 4- ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel Mepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ,.XIS-rft..ic 1J c_° -4�+2, " ►o►sal- otu; - ,i- to..k2do AtZWATUtaredllt-ACI '' 'ZC5 . <br /> ' iv.itOt5 1..tsti4It 4�'1F+�1�s, e,5 "Fort✓ -5 bM- 5-11100c • <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 I 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.: • :being authorized under any circumstance.I am the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> and I compl 'ith the St: -Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> D <br /> \ 12 I� (�/,c�I� PERMIT r <br /> Ow -r/Aut • ,Agent Si nature e (Revised 9/23/2016) <br />