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grrPERMIT 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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ,.A to"'/— LI,eAl - Q s ct PROPERTY TAX#: COSI to g S-930((P00 <br /> LEGAL for new construction: Short Plat/subdivision IAA\k"-el °'�-�44!tAt/� Lot No. It,$1i(attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 'c_tA 504.c4--t-i TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET `1S) (41 sr qibtL A-)C <br /> crry L.tk Ste_u-e.AAS STATE (Al .4 zip `I'S,'LS 6 <br /> OWNER PHONE: `T—S 75z/ i-kot7. OWNER EMAIL: C. +•e"'i,1)-'Si.Gj✓I G%(v Oa,4461 S f lU e T <br /> CONTRACTOR NAME: 5',4 vii 6 <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 1FLOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 5.P g_ -/AGA.r r LOT Contract Price of Work:$ I K <br /> Proposed Use of Building: S F(- Heat Source: XGas CI Electric ❑Other <br /> Building Type: )-SFR-Detached SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: $New ❑Addition DRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler DDemolition DChange of Use <br /> DESCRIPTION OF WORK: CO 4 7 G Nmow 5-i/LIGLE. rA,M4L, ea S 0�1icu <br /> T l �— <br /> 1J/V c J / l 9.--:_p, <br /> ASSOCIATED UILDING 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 #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units / Heat Pump 5 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater I Bathtub Urinal <br /> Gas Piping Boiler S" Lavatory(Wash Basin) Drinking Fountain <br /> 1 Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove 1 Kitchen Sink&Disposal Grease Trap <br /> ',7-- Gas Range Ducting I Dishwasher Roof Drains <br /> I Clothes Dryer Hookups Other: I Clothes Washer Medical Gas <br /> : - Range Hood Water Heater Other: <br /> A Exhaust Fan JJJI Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number 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/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> / City of Everett Official Use Only <br /> PEF2M(T# <br /> Owner/• h. zed A:'�rSignature Date (Revised 5/20/20 6f) <br /> (IIS <br />