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"IPPERMIT APPLICATIOI— <br /> BUILDING/MECHANICAL/PLUMBING /SIGN/SPRINKLER/DEMOLITION <br /> viiigWi CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 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: I 620(7 /'1APL e S-" PROPERTY TAX#: 0 060.0/06 200 9 130 <br /> LEGAL for new construction: Short Plat/subdivision V I C.4 DRy 14-6?6 gig 6144Z Lot No. 9 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: CEJ(a SIN4P,$Dhl TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET / `2D /2,4PLkr sr <br /> CITY .._ve Q�'jJN STATE J* �p- ZIP 7u 241 <br /> OWNER PHONE: 2D6 '792- 163i. OWNER EMAIL: Jerfi5 ,pSOae5/116 1 ('COlt^ <br /> CONTRACTOR NAME: Ne...,AL 'A-46S I A. e- <br /> CONTRACTOR ADDRESS: STREET /' I( PbT ArI e+ £tAGI+ RA L <br /> CITY FL)C.J4LI lp )STATE -v ZIP C2S 2:,/ <br /> CONTRACTOR PHONE: 92-s- Sb?✓ 9752- CONTRACTOR EMAIL: -6-. e.1.4.1S &/op..t i-C.v. -1.4'et)A. <br /> CONTRACTOR LICENSE#(REQUIRED): eS1C I C(71 0 8% T" CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER Ld26NTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Z}'ZS- $D 5 4-75-Z <br /> .J) 0 Ir..-SL76J CONTACT EMAIL: ed. ©ISDN<° P4c.1‘I ..Cees, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: G GA Contract Price of Work:$ 3'O/000 <br /> Proposed Use of Building: 6A.e." Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ©SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: E34,,,,44...4 z.X icT.ve. IZ.,,,z...4.1 &44&& rs Z q„,12.e? 64 4,,Lar <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 epair <br /> #of #°List of Fixtures List of Fixtures #of List of Fixtures #°f Li of Fixtures <br /> Fixtures Fi• res Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflo Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Uri <br /> Gas Piping Boiler Lavatory(Wash Basin) rinking 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 D -r Hookups Other: Clothes Washer Medical Gas <br /> Range •od Water Heater Other: <br /> Exha t Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I No.of Heads • <br /> ACKNOWLEDGEMENT:l 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 tate Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PE T <br /> . Le /f" . e 2d410(a ' <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> (1-7z_ <br />