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PERMIT APPLICATIOI'I- <br /> BUILDING / MECHANICAL/PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> /11111111*/id CITY OF EVERETT PERMIT SERVICES t <br /> 1/ 1 3200 CEDAR STREET,EVERETT,WA 98201 �-� C2 l ©--6 8 <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 ,/ <br /> PROJECT SITE ADDRESS: 11.(e Lc— ( ( �L SE PROPERTY TAX#: Z3d c3OCC YO/L <br /> LEGAL for new construction: Short Platisubdivisiont ikc- 1 561 zb Lot No. '' <br /> S (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 14G G r c <br /> v �.,Ll5AT5 /4/1715 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: os d G~Y�re..-e ri1�� /C cJ <br /> l-' Y` e4 STATE /LL ZIP f V Z 6 <br /> OWNER PHONE: l 2....0----, Cir <br /> 9. , 5 7 7 OWNER EMAIL: :it/AZ_ <br /> CONTRACTOR NAME: Gs1' ( 1 LO e iTh to- 14- /3 D/-N. ' / rte.- <br /> CONTRACTOR ADDRESS: 10. OW- /56-7/ 27Z- <br /> v ' _ , _7- . _ STATE �4----- ZIP d9A 2.-Ci0 <br /> CONTRACTOR PHONE:3I,:24) -`,3/' � 91-7 CONTRACTOR EMAIL/22 Z.j///G 4, 74('1/1-7141— <br /> CONTRACTOR LICENSE#(REQUIRED): Ai/!/ f*We) CITY OF EVERETT BUSINESS LICENSE#RE UI `-'6 <br /> ( Q RED). ��D1, <br /> PRIMARY CONTACT:,1yQWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: D � CONTACT PHONE: tet-,c-."-tet-,c-."- c"- 2 r o754' <br /> DS - !r �'�� <br /> ���-v,�/-t CONTACT EMAIL: 1/17 IGY� to fii,'"Art C,,E,S,y�-, <br /> BUILDINGPERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ <br /> Proposed Use of Building: 'S P Heat Source: ykas ❑Electric ❑Other <br /> Building Type: ' SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: El Commercial ❑Industrial <br /> Type of Project: P-0 ew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTIO .giF WORK: �� <br /> ......q.e.,;:f/e-, %'/,?: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: XNew Addn Alteration __Repair Type of Project: New Addn Alteration Repair <br /> #of <br /> — <br /> Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures #of <br /> Fixtures Fixtures Fixtures List of Fixtures <br /> NC-Air Handling Units Heat Pump '? Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Z Bathtub Urinal <br /> 3 Gas Piping Boiler ,t;" Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration / Shower Floor Drain <br /> IGas Fireplace Wood Stove } Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting i Dishwasher Roof Drains <br /> ( Clothes Dryer Hookups Other: ( Clothes Washer Medical Gas - <br /> I Range Hood <br /> I Water Heater Other: <br /> 5" 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 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 <br /> � tt <br /> off Everett Official Use <br /> Only <br /> ----.. Q° <br /> 6/7/l� PERMIT[ ! 0 lU - v it <br /> Owner/Authorized A ent Signature 9 9 Date (Revised 9/23/2016) <br />