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PERMIT APPLICATIG 1 1 1 <br /> BUILDING/ MECHANICAL/PLUMBING /SIGN i SPRINKLER/ DEMOLITION <br /> GUY 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 1 www.everettwa_gov/permits <br /> —„, <br /> (Blue or Black In Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 5O1c1 R..kx, AN e PROPERTY TAX <br /> LEGAL for new construction: Short Plat/subdivision - Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Nit 1)./..•#‘ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTRee-r 5a1CI kW ck.e Av-e- , <br /> are CAleie_, -- STATE W14 ZIP CI gacy. <br /> OWNER PHONE: t-kcci(6-3, -TA in OWNER EMAIL: .7 <br /> ' . <br /> CONTRACTOR NAME: Gyfemuslockt kW\138 V AL <br /> CONTRACTOR ADDRESS: STREE f g25_6_ Skaak_a_ <br /> *._ <br /> CITY SaA4-4AQsTATe w cl- ZIP q.Mkji <br /> CONTRACTOR PHONE O )14—USA,c5 CONTRACTOR EMAIL:vemAs(;) 0-evuxrdveck-1:1%.CO <br /> CONTRACTOR LICENSE#(REQUIRED):a\-2_eel•A kAAC2.2.--kr+ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):043q5 <br /> PRIMARY CONTACT: 0 OWNER li::: CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (2c 1C(*-1— (M <br /> CONTACT EMAIL' •i, U.c Pit - #,.. <br /> * i " 1J * "I <br /> . .. . ..... _._ _....,. <br /> BUILDING PERMIT APPLICATION <br /> .iatax) <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: kiliGas IDElectric DOther________ <br /> Building Type: EISFR-Detached b4rSFR-Attached ODuplex OMulti-Family-#of Units: ElComrnercial 0 Industrial <br /> Type of Project:IgNew DAddition ORemodel EIRepair DT.I. ElSign OSprinkler 0Demolition DChange of Use <br /> DESCRIPTION OF WORK: <br /> -14-‘40A\ boave. Cas cope- .\4(xx\ Tiya-Qx- (to \--06k1e)c. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 4............MIWITIMW <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: 10_ New Addn __Alteration Repair Type of Project: New Addn Alteration Repair <br /> #of #of I/of I/of <br /> List of Fixtures List of Fixtures List of Fixtures 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 /> ..., <br /> 1 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 /> — _ — <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> ,. . , .. <br /> Chemical or Water No.of Heads <br /> . . . „ <br /> ACKNOWLEDGEMENT:/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/8.27 ROW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Owner/Au wrized Agent Signature late (Revised 9/2312016) <br />