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4-17- PERMIT APPLICATION <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 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1,01g 1,-)at - c PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ' cLtjlck , ,-=,.,,,,j9(), TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1.1`q2\ %p i2e9 . <br /> CITY # 1, „✓,Art„..," STATE t...,-&- ZIP CiS2 Z 3 <br /> OWNER PHONE: 2-0t' ''O 6a OWNER EMAIL: 6eo2r4,k 0 ed splc/>A�, /k-irm:., <br /> CONTRACTOR NAME O er <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: PPOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 2 CONTACT PHONE: �b q a000v <br /> Fi-e.oLt,•6tIC ci7+•-1046... CONTACT EMAIL: ��'' ick Q edeha tiS/044 tncy 1/c.Co" <br /> BUILDING PERMIT APPLICATION (1 <br /> Existing Use of Building: grek IW.tl y Contract Price of Work:$ 1001000, <br /> Proposed Use of Building: C-- u- l .qtly Heat Source: DGas DElectric DOther <br /> Building Type: ❑SFR-Detached laSFR-Attached ❑Duplex ❑Multi-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ❑New Wddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: _ca.kl Tv t 9, 144.1,7proya<r4-y. Q <br /> 96 ,F C '1.': iMtagt gr\.. L.. <br /> �. a2, SS'Iv ,,IAaet @ v►ti pioulo+�'JIt.�" <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ?� �"`t <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New PO 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 /> Fixtufes Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units t Heat Pump Z Toilet Backflow Preventer(Inside Bldg) <br /> 0 ForcedAir Systems 0 Unit Heater - Bathtub 0 Urinal <br /> / Gas Piping 0 Boiler z Lavatory(Wash Basin) t) Drinking Fountain <br /> s Water Heater '& Refrigeration Z- Shower 0 Floor Drain <br /> s Gas Fireplace v Wood Stove 4 Kitchen Sink&Disposal O Grease Trap <br /> = Gas Range Ducting Z Dishwasher Roof Drains <br /> L Clothes Dryer Hookups Other: 7 Clothes Washer Medical Gas <br /> t Range Hood y eatlawF� e�"-- Other: <br /> a Exhaust Fan D 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 /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ` // City of Everett Official Use Only <br /> PERMIT#nl t <br /> „ 100 V 1�olI �6\27 �� <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> 612.... <br />