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PERMIT APPLICATIO <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 <br /> PROJECT SITE ADDRESS: 2 &O2 e Gi(c vt ,ode PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision (.-Nn Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: S,L ,1 i p S TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2.2 5 \)Q.{l7(.2f) Roil <br /> CITY L q k.e 'feJzh s STATETWA ( ZIPq c <br /> OWNER PHONE: 2€2 7.7-� S gi OWNER EMAIL: `rel 1<eS l�t)�Q j.�z& d' c(.2Y1,1 <br /> CONTRACTOR NAME: OW°'(Q^( <br /> CONTRACTOR ADDRESS: STREET S'cT Q <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: 2276 77--k 5&i' CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: XOWNER 0 CONTRACTOR 0 OTHER(Please Specify) _ _ <br /> CONTACT NAME: �j CONTACT PHONE: 2.0C 7 z S,-6 <br /> {aIZ �ewCt�(av` WSF t CONTACT EMAIL: i cke ‘k; Z Orichif,c6;'01 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ZeS Contract Price of Work:$ t 35;.O©12 '— <br /> Proposed Use of Building: R.eS Heat Source: OGas f Electric ❑Other <br /> Building Type: XSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition KRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ero44J ware, Re coNe (cow( 4ion V\i/1(. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> T. •of Project: New_ Addn _Alteration _Repair Type of Project: New _Addn Alteration Repair <br /> # #of List of Fixtures List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> —Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forc-. Air Systems Unit Heater Bathtub Urinal <br /> Gas Pipi • Boiler Lavatory(Wash Basin Drinking Fountain <br /> Water Heat- Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher '•of Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Me. :-I Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION S EM <br /> Chemical or Water INo.of He- • \ <br /> ACKNOWLEDGEMENT.'I have reviewed this application and confirm the in mation 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 ap.oved 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 /> c("'"‘ 1' -3 r. ► Psi `z „cc <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> 4.2) <br />