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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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> FROJECTI SITE IN1ORIVIATION <br /> "($#ue.oX Bt4cJ(Inik Only Please). „.,v ,,.,�, _ „„ _ .,. . <br /> PROJECT SITE ADDRESS: 1 'CI PROPERTY TAX#:/:31:301752712,..0 t v <br /> LEGAL for new construction: Short Plat/subdivision f4�eNlS ( A 1 Lot N12r I4 (attach copy of long legal description) <br /> ; J , ' gas <br /> OWNER NAME: j t„,>;,,,',,: <br /> /�'t ' 4 E&., CiDO' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: l STREET t 42,g .F� -c u T (�V v <br /> ITY c�„�j <br /> CV Cc STATE W tr ZIP 915-2,0915-2,0k <br /> OWNER PHONE: 7 "7OWNER EMAIL: -' Cod CJ r 1:::00LAA.eA . C..fl". <br /> CONTRACTOR NAME: /1► 0 4J"id .--}f _(f J4W LOC O <br /> CONTRACTOR ADDRESS: STREET f <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> : <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) <br /> PRIMARY CONTACT: WNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: / CONTACT PHONE: 42 C5.??7..37�(, <br /> �J� hr�TA1� CONTACT EMAIL: M+ ep5-s C��pc1rJ2Je'IfA 'IWACV. "- <br /> " ,: BLt LhiNO<PERMI APPLICATION. ";,,, .. <br /> Existing Use of Building: Std- tract Price of Work:$ q 0 s• <br /> Proposed Use of Building: (...- 444 / ot4Y . *.k t Source: ❑Gas ❑ ther <br /> Building Type: SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: <br /> OCommercial ❑Industrial <br /> Type of Project: New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> NgArsi Att4=',Ctsre \ z)k,Ut.:A.N.Sev vg‘''1, r- VAri\Rxy( ( vAliskg n„ 12-era ei\. kroccisAktic) <br /> ASSOCIATED BUILDING PERMIT#(if ap licable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING API'L,IcATI'ON',. <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 /> NC—Air Handli g Units Heat Pump ( Toilet Backflow Preventer(Inside Bldg) <br /> I Forced Air Syste s Unit Heater I Bathtub Urinal <br /> Gas Piping Boiler 2Lavatory(Wash Ba in) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Dispos Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hoo ups Other: Clothes Washer Medical Gas <br /> Range Hood IWater 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.Th- . ting 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 uthor' -d unde 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 St- - 'ont.ctors Law 8.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ICE4:/ 1\dicq()2 ' .Cl()Th <br /> Owne •utho''15 Signature Date (Revised 9/23/2016) <br /> mss' <br />