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PERMIT APPLICATION <br /> 41111114 BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> / CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 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: : --il ,?}' C /' p. //re L G�re 20 Li.,/"9 PROPERTY TAX#: CC 5/3q/66 .si0/ i c <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �) <br /> -5Xc�, yid// / /-/..' / eS 4 fes' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET t�Pc /q ( S.-24i / ) <br /> CITY L I/G7 e STATE 41,1 ZIP <br /> 1 ./p[1CT 6 <br /> OWNER PHONE: '.25 '.,e)5�.ti? - S9fQp OWNER EMAIL: e cr de/:S6 4 54,7E g 1, eOx-i <br /> ru;� n �� lei <br /> ,e/ <br /> NAME: t1J,Lr//'e tP/o„,,,, ,h <br /> CONTRACTOR ADDRESS: STREET 73? I J <br /> ! r yE ,51 5'6- Brae <br /> CITY /7)OA'ye_ STATE G*: 9 ZIP 9 8.e27 <br /> CONTRACTOR PHONE: e`25 36' 7 ' 7q.7Q CONTRACTOR EMAIL: /%�,./{r ,7 a 4..„ ,4 / , Co/y-7 <br /> CONTRACTOR LICENSE#(REQUIRED): Cif l(f'p, :✓ 3 3 e'i CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 3,476 % <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT� i' ,,,,-,,,,�[JNNAME: CONTACT PHONE: 11-Q5 3(7 )y„2„� <br /> 74, /�C � � /j7� <br /> /, CONTACT EMAIL: ivy:A-e � G//c7)7.-eo,71 <br /> _ BUILDING PERMIT APPLICATION <br /> ExistingUse of Building: o <br /> fe n�C Contract Price of Work:$ w . <br /> Proposed Use of Building: 0 Heat Source: ❑Gas 0Electric1Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: L Commercial ❑Industrial <br /> Type of Project: ❑New DAddition 1321(model ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ,eq 71.- /00irr) (CtS.`arrQCm ---C7i'Ve;1 -, 3 tire.../ bis�✓✓ ,fekren s Z oc --oo 2 <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 /> Forced Air Systems Unit Heater Bathtub / Urinal <br /> Gas Piping Boiler 1`; 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Owner/Authorized Agent Signat re Date (Revised 9/23/2016) <br />