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OLT 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: Li i7 ;✓tr'rOl PROPERTY TAX#: jYU0Y)I[.>LlCiCt <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:(1.i 7 N)'1-1-\(�1c ? fl -(1-{-S TENANT NAME(If Commercial): -12-41-1,--)Cf ') •,—, c <br /> OWNER MAILING ADDRESS: STREET I(48 5 Lt:_fp y.-1, ..+ C )rok_r t1-1\j(: _ <br /> CITY lir.)Cti(Th loLwC( STATE C.,- ZIP q/ 770 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ��1 fTh' t'()f.Yi-, 1 v 0 <br /> CONTRACTOR ADDRESS: STREET „U 1 C? r ' ����\i iZ Jed <br /> CITY 11 1(\31\ Il\ STATE (.... ZIP c4 <br /> CONTRACTOR PHONE: j(c(...7-(�7/- 6Lf� J CONTRACTOR EMAIL: a) � - s,, ,,t(1/T f J- , d1 <br /> CONTRACTOR LICENSE#(REQUIRED):SJ6 I*C 01 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):(0(,J <br /> PRIMARY CONTACT: ❑ OWNER ryl CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: p CONTACT PHONE: 3 kPO ,�� - <br /> , 7 /- 13`i5 <br /> Lo L 1 _:%,, CONTACT EMAIL: Lo ' C�, 1-h2 - ,: c•`� /r <br /> J Y <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: OO('i1 vyyd-(j.,c.e ( /rr`-e k(-6-,,J- Contract Price of Work:$ , CAI) . (IL) <br /> Proposed Use of Building: N-;j-,I 11' C_tYp l re56„,z„; - Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Mtommercial El Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> /D'�ESCRIPTION OF WORK: I,3# `i;,-,3- ( Ac <br /> rVrlc.a_rr.F-cam .5,cj175 ) k� &a Siy6 i pt,--7s 5 pt-- S <br /> lJ 1 5 in,(911)ni I( IA-r° A rC'z -;CYr I s ir,P1, .\ Ii %ve `F cucSe;hS - <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 Toilet Backflow Preventer(Inside Bldg) <br /> _ <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 ,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 /> 7 ...kPERMIT# <br /> O` er/A or e8 Agent Signatu - Date (Revised 9/23/2016) i <br /> 1Oz <br />