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' PERMIT APPLICATION III I <br /> BUILDINA /MECHANICAL/ PLUMBING /SIGN /SNINKLER/ 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 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION / <br /> PROJECT SITE ADDRESS: J7 q03 FQW`� Alt )� PROPERTY TAX#: 00 394 60 000000 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:4r1,1641, 0.Lcdn9nex,3r 1-1" i), LRAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ye/03 fDr� ' ( fire, <br /> CITY f _J e'th Ren <br /> STATE ^^ fR)f ZIPg3A� 3 <br /> OWNER PHONE:'7 ,`5� 3 71 Lip--. OWNER EMAIL: RenOla GCJ! (f . Corn <br /> CONTRACTOR NAME: <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: DOWNER 0 CONTRACTOR 0 OTHER(Please Specify) • <br /> CONTACT NAME: CONTACT PHONE: 33q.-- J1/ /0_01_, a?5 3O% /„3 <br /> KeAl L 'lei- CONTACT EMAIL: K Ota 1 kPfrIknOt , <br /> corn <br /> ,�!/►$'�.BU,,I(LDING PERMIT APPLICATION /► <br /> Existing Use of Building:oI -Fa4rll _ir'Q51UUI Contract Price of Wor $/OO 00 <br /> Proposed Use of Building(0 ;/ A D tL in kovr►.e- Heat Source: Qas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached FR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: , <br /> bar k► dors 5 in 1��- i dqe +o Kil-tJh�,n.Iq �,e. n �n,- <br /> C�I�o��( Co JC r s;o e "C '24q Axe gb i AD v , rG�U, r ' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): vollt ,t QI ry� Z <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 Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove / Kitchen Sink-a Diapenol- Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> f Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water ' 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.l 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 Ste Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PEtaaniT <br /> I or: ,of Oc.4- I? ;Y,)15 <br /> 04 0611- DO5 <br /> 0 , er/A k iz d Agent Signature Date (Revised 9/23/2016) ` <br />