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PERMIT APPLICATIC <br /> ,laPP,AV-_ BUILDING / MECHANICAL/ PLUMBING /SIGN I 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: 42a4CD gi/�, PROPERTY TAX#:i ja0(p 503.20!)AIM <br /> LEGAL for new construction: Short Plat/subdivision�f ?;lignsierf, Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: bEr)44 ' 14.0.,0 35 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 42446 a LLS Fri/E 4 <br /> CITY I/ 0'�- STATE LOA ZIP 7 8 <br /> OWNER PHONE:.. v3-I OWNER EMAIL: giw4'3ceRE3 P '4-# o. e_04,..,_,_CONTRACTOR NAME: J <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): ,�/ CITY OF EVERETT <br /> �BUSINESS <br /> LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR tp OTHER(Please Specif �� <br /> CONTACT NAME: keu-Y 1r J 7liE.Q0.. ► CONTACT PHONE: /1<y_r sb?,..c9/f j <br /> !Iiturrit.Teit„ AGAT5 Svr14-K. `+<' 44. CONTACT EMAIL: Q b / �f hoa�-Ir)p1tr Any,"" BUILDING PERMIT APPLICATIO <br /> Existing Use of Building: ...SPI-o.? Contract Price of Work:$ <br /> Proposed Use of Building: .2*op Heat Source: ❑Gas qglectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New OAddition ❑Remodel ❑Repair OT.I. ❑Sign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK:' e t1C-1 f Ex/sr/14y ay-op p el i L6 Pa i <br /> tai,4 4& STra&e L ILE' g_04-1-1 LI L1./ /lr a Size or- silty° FX.OW) /O x13 <br /> 1o? 4 /hbvc o? fir- MX-T}IEK., LL,C -- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: New _Addn _Alteration _Repair <br /> #of List of Fixtures #°{ List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C–Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Syste Unit Heater Bathtub Urinal <br /> 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 /> 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 /> 1110 , le, Wtt ) PERMIT# <br /> Owne ,•. -.rfzed Agent Si.T ature Datef2:1-1. (Revised 9/23/2016) <br /> 2 <br /> Z <br />