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PERMIT APPLICATION <br /> 11 I <br /> / BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER I DEMOLITION <br /> f CITY OF EVERETT PERMIT SERVICES <br /> 7 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 ((E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3Ili 01\fvn/gc, j3Ivd. 1-Vifetjt� O, PROPERTY TAX#: 01.7ae a ziev1 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> !' CONTACT INFORMATION <br /> OWNER NAME: No ** - -E 1 if Z4&k I StGuyinio TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3)V o fY R'( 1 1/hp i L. B ) ds Wk. <br /> G� <br /> C -�Vl, tjt 4 STATE Wk ZIP `-A >3 <br /> OWNER PHONE: 'lz' 317- ga11 7 OWNER EMAIL: cfb0.4enlra-c-titil 1.r0}'Mai1 - COV7 <br /> CONTRACTOR NAME: 4-1,9,1,_ Co 6}f ir.1± I�(4C_1-.11, <br /> CONTRACTOR ADDRESS: sTREEr 3112 -t...12 z)/ yj�'/19 IL , itJI. ,p <br /> CITY &ii-f ' STATE/4 f�i ziP 9e1�/�3 <br /> CONTRACTOR PHONE: �.5 {3J — ¶a. 1 7 CONTRACTOR EMAIL: F4/? ,"""��."'�041'r i:v,' tact l•(Pm <br /> ) '7 l <br /> CONTRACTOR LICENSE#(REQUIRED): (9 d, 00 21 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): i%J l�d'41 6 <br /> PRIMARY CONTACT: D OWNER - CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: t ,q 5-- '?y )q �) 17 <br /> r49k-u,y1 1 r- CONTACT EMAIL: cc49 J? c_fl yV1 j. hL /41 i ` aUtn? <br /> BUILDING PERMIT APPLICATION a 0 t <br /> Existing Use of Building: (-'>,`Ire I, -Crir-i y), I L,L./'!r' Contract Price of Work:$6 \ ` ( <br /> — ^L.---- — <br /> Proposed Use of Building: S i vy�.) culfh‘-,1 y L v$ Heat Source: 0,Ga ❑Electric ❑Other <br /> Building Type: SFR-Detached ✓❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑industrial <br /> Type of Project: ONew ❑Addition 1 3Remodel ❑Repair DT.i. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ��� tGc ec )41( or�z'1 14 <br /> ,� v, `-e)i-!St Yom,' 2 4Z-r•�'`Z��-�t.' -5_ �. <br /> ✓ �tO T� <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 #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 i, Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler i Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration I. Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range 1 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 I 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.lam the owner.or lam authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the e ontractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ji tO/31/I r 1 <br /> PER # <br /> Agent Signature Date (Revised 9/23/20 <br /> O ertAu g g <br /> ////2-- <br />