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Ore7TPERMIT 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: 4./....,W 4/8' //,V ...s.6-, PROPERTY TAX#.276)5i3,/003 70 ?a0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> V, ' <br /> ' / CONTACT INFORMATION <br /> OWNER NAME: i&e,€7 067//x(6 TIN../ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET X70 V4' "A ""/ S 1, <br /> CITY Z''' et-el-1 STATE/E �. ZIP 9 <br /> (/j.2C,3 <br /> OWNER PHONE:�,,2�—,2Y-G3'®3 OWNER EMAIL:Ao,i Z/oe/ /..5eq/77 ;/ co/7-7 <br /> CONTRACTOR NAME: „4/64S 6,,,sUcr4 i <br /> 6/A7.,, ,?/"- <br /> CONTRACTOR ADDRESS: STREET(.262,20 7 , , � y Road <br /> CITY S�,A,yIbt/00 C J/ STATE., ZIP 1 94,2.9'2 <br /> CONTRACTOR PHONE: �a�.-3S-� /7 9 CONTRACTOR EMAIL: y',gncx/e /�/P_.,5 C0'7$/t cI c <br /> CONTRACTOR LICENSE#(REQUIRED): L:/T// cy l C C / 7 3 0 3 CITY OF EVERETT BUSINESS LICENSE#(REQUI D): 6-$74 <br /> PRIMARY CONTACT: 114OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ..!:,2,..c":,-„2,;„20—OSCS <br /> Xie/7--- L4C/147// J CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION Oo 0 <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New tgAddition ❑Remodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: C,. A��/1�� s/�fde4// <br /> J 1j21° <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION P UMBING PERMIT APPLICATION <br /> Type of Project: New_ Addn _Alteration _Repair T .- . Project: New _Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #o List of Fixtures #of List of F' ures <br /> Fixtures Fixtures ures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow • -venter(Inside Bldg) <br /> Forced Air Systems Unit Hea : Bathtub Uri <br /> Gas Piping Boil=- Lavatory(Wash Basin) 1rinking Fountain <br /> Water Heater 'efrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hooku. Other: Clothes Washer Medical Gas <br /> Range Hood Water He - Other: <br /> Exhaust Fan Sink - vice/Bar/Mop/etc.) Other: <br /> SP' . LER,/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 /> �Date 1;4 (vs -QL 2 <br /> n /Authorized Agent ature Date (Revisea9/23/2016) / ` <br /> / ti/ <br />