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PERMIT APPLICATIOI` <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OrETT 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) iPPFT"��OJECT SITE INFORMATION ,,-6�/ <br /> PROJECT SITE ADDRESS: `�i0T/` 5 � PROPERTY TAX#:O(� 12'1'0 6101e247 <br /> 46 LEGAL for new construction: Short Plat/subdivision. N I I�i1,O/q' J(4 I 'Lot No. (,co(attach copy of long legal description) fee1 14_,I., _r_d__, <br /> r CONTACT INFORMATION <br /> 1 fi <br /> � a' <br /> OWNER NAME: PC. � C 2 TENANT NAME(If Commlrcial): y <br /> OWNER MAILING ADDRESS: STREET • 20 Z t 0/J 4 2_-�(�D 1:--- <br /> k, <br /> � YYYY �/] <br /> CITY I (/ ` C/ (STATE4 <br /> IA/ ZIP goo / <br /> OWNER PHONE: "4_ ej-D. 6 ! 0 1 OWNER EMAIL: c (4 O Z GVtcCJIONG13 .Ct ` <br /> CONTRACTOR NAME: 4�� 1 J <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED)Q ReSCi A27-3 OA/ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED: 22 790 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CA (40 r n /6 CONTACT PHONE: '�.. 3 f '2 t el, , 7 <br /> ? ,,- v__. 2 (��.� CONTACT EMAIL: .rC41 J of O"yA ' 1 Cyr-p/�'`0•/j <br /> UILDING PERMIT APPLICATION <br /> Existing Use of Building: /177(//0 IA G1 k Contract Price of Work:$ 47 / �l/r 9 <br /> Proposed Use of Building: c' 11 4. ��ti ^ A 0d Heat Source: ❑Gas DElectric DOther <br /> Building Type: ❑SFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family #of Units: 11Commercial El Industrial <br /> Type of Project: E]New DAddition El Remodel ❑Repair ❑T.I. ❑S7ign ❑Sprinkler ❑Demoliti ❑Ch nge of Use <br /> DESCRIPTION OF WORK: !Rep I e_ u/!-A/k RA't),‹ ,, A c./� -? 0 a- <br /> ItArd t (VP) 4 d 1 4/13/ 4 e cz e- i P-2-10 a~g-A , <br /> di ' i0fexpfsd A• 1 , /�A ex1 71.y�0/1pPo(t_�/ 4 rl kihey <br /> ASSOCIATED BUIL ING PERMIT#(if applicable): 6./! r\ v ^ ro V� , Q i/ovifivi <br /> tiveP <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION 4 1 <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 /> 141,1447c1 I com ev with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> .,, 'r��---- /11 ` PE�� c i/5' F/ 9" <br /> /Authorized Agent Signature // 1 Date1 <br /> ��a' 9 9 (Revised 9/23/2016) <br />