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gn- 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: j, Z/-- (<rOV1n'Vl PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision j3(k'77 Li tv+ i 1.6C' Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: km& af 4- pewwEES TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 412.2_ 6'141\ .4A-E- U C- <br /> CITYmicoNts L/t t le_ STATE `Jt- ZIP g e C�70 <br /> OWNER PHONE: Li 2.5--2` Q`-2 1 2`f OWNER EMAIL: J vel[ tlacks.L.br k-Aev-S: t o i(v) <br /> CONTRACTOR NAME: 14 ()LCGL 0 TO—k-lete rj t-tewve$' <br /> CONTRACTOR ADDRESS: STREET 39?Z 0-7'tom N-c- N r /� <br /> cm( (V\t.\( ); lte_ STATE U `ZIP" 9S 1_7 V <br /> CONTRACTOR PHONE: Li Z -1 <br /> S2t' 2-LiL9'- CONTRACTOR EMAIL: S 0e C_ tQ <br /> vICtL bre 4*. (0"-I �7 <br /> CONTRACTOR LICENSE#(REQUIRED):t4jL 13 Tot a D "Z CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):()539 6 / <br /> PRIMARY CONTACT: 0 OWNER IR CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: ` i r�v�CJ` •.. <br /> tCONTACT PHONE: qz_ _2 '7 C... Lc a ? <br /> E -FC"� l� 1 <br /> CONTACT EMAIL :cp\NC1Lt d<bripetrS,C C)i,� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 2 <br /> Proposed Use of Building: S F - Heat Source: Was ❑Electric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ,\? E;(0 S Fill 0-di i1r t \�+c ti-&►0 (, q,/ 6, <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 /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> NC—Air Handling Units ( Heat Pump ! 3 Toilet Backflow Preventer(Inside Bldg) <br /> / Forced Air Systems Unit Heater ,a, Bathtub Urinal <br /> Gas Piping Boiler 5- 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 _,y1 Water Heater Other: <br /> Li/ 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 /> �\ j W _Z r, PERMIT# 0- 1S65-(XJ nc-o i <br /> 7-7 Ow r/ thorized Agent igna `-� Date �j (Revised 9/23/2016) •J <br />