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POF ERMEVERETTIT APPLICA <br /> PERMITSERVICTIOI- <br /> ES <br /> BUILDING/MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> CITY <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„I lei ales-MO- SEvereit PROPERTY TAX#:2-c1 OG2-000103 2D0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Pau I -1-beavwcc.3e fEcr TENANT NAME(If Commercial): NI/Pt <br /> OWNER MAILING ADDRESS: STREET �-2V'I ins $t <br /> ( CITY 6fe-7 rc W l(e�\,,JJ STATE A/A i ZIPg8' <br /> OWNER PHONE: pC(L( 1 l�-I / 5 OWN REMAIL: (LiI t Se Isov Ev OUBICC k i CGV en <br /> CONTRACTOR NAME: QWil ex , <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4.2. ,CiL. f ,71S5 <br /> Pc A t S e l sor CONTACT EMAIL: 1- .l u t P ase t/(.50rm. (,x,11 , i ►1.�4�W( <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: (,4 Dit' ( Contract Price of Work:$��4,0,DOD. i <br /> Proposed Use of Building: ��.C. I Cj( Heat Source: ❑Gas t)fi'Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached Ilex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel Crepair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: f„11 _,r. iZvvrvA)G— P-li- t-S /Ztr(,76 *J L <br /> �' ci I r/ r�p f a�, f(xficArp�y}c�s` �� lecl ,, <br /> ASSOCIATED BUILDING PERMIT#(if applicable):c`rri(r! v ep I c- Cicacc ` frc�' <br /> MECHANICAL PERMIT APPLICATION� PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn Alteration te Repair Type of Project: _New Addn Alteration V1<pair <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 t Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler i-l• Lavatory(Wash Basin) Drinking Fountain <br /> 2_ Water HeaterWjec) Refrigeration Z Shower Floor Drain <br /> Gas Fireplace Wood Stove L, Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting i, Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Was r \ Medical Gas gyp/ <br /> 2. Range Hood _ulrat�x�!ea#e /L, Other:Shitt D+ l <br /> Exhaust Fan 03416 Sink(Servic ar/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 /> P PERMIT# <br /> 4f... 7, <br /> ner/Authorized Agent Signature V <br /> r (Revised 9/23/2016) <br /> 1''') <br />