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PERMIT APPLICATION <br /> ,, BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> 0111 CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: I,(0 6 S rci ,S-/- S L- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: SOP,-/ 1N YA\ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET I b 1 G S fd j/ Sr✓ <br /> CITY CV E e c STATE WA ZIP 73203 <br /> OWNER PHONE: L4?c 8 H Z.S 1777 3 / u3S— OWNER EMAIL: SQ j77/,9 A/ " ..4-1/4"/ c � a 0 _ f o,�-' <br /> CONTRACTOR NAME: S jig/f 4A,/ r'4 y <br /> CONTRACTOR ADDRESS: STREET /(p (0 e 3 fi SI 567 �} <br /> CITY elf t/�`!STATE `�v M ZIP 71 /! <br /> CONTRACTOR PHONE: 425.— f9 7 5 / g 3s- CONTRACTOR EMAIL: $ori-p i f yx)1(0 tj.11 rta b. 0✓ti <br /> CONTRACTOR LICENSE#(REQUIRED): 5'o p/44AJ 6 9 11 LK CITY OF EVERETT BUSINESS LICENSE#(REQUIREI):ry OZ„-17 g 7,7 <br /> PRIMARY CONTACT: [3-OWNER 0 CONTRACTOR 0 OTHER(Please Specify) �,--- I�`..`Ir <br /> CONTACT NAME: CONTACT PHONE: Lt ZS" —1 2 3 /$p3_^ W <br /> .5 DPP rvk/ y4,./ CONTACT EMAIL: fj p7-rAA/ \y/f---f a. 4t-7_ o `-‘ <br /> BUILDING PERMIT APPLICATION 60 x13 <br /> Existing Use of Building: ;fie s;d� .r/Q. f`ct Yii�G'1 flirt f&Contract Price of rk:$ `v4��0 <br /> Proposed Use of Building: iQ S;d(Q n( ti / i, ,f I W3 k< 6:4M,y_Heat Source: s Electric <br /> Building Type: ❑SFR-Detached SFR-Attached ❑Duplex ( 1Multi-Family4 of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New (titAddition- ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: / <br /> PCid, 5 coo" 6`4iv? 4,--et kc <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 74Addn _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 Handling Units Heat PumpToilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems 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 I I - Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> !Chemical or Water I INo.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 aut •rized 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 Co .ctors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> . PERMT# <br /> 04 40KQ t7 C. V2 On e <br /> Owner/Auth o ized Agent Signatu - Date (Revised 9/23/2016) <br /> (1)' <br />