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PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING I SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> Orren- 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I 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: i4-1C.-7' rj'Z^ Gj 9 --}— PROPERTY TAX#: C,41-(Cy °S t', <br /> LEGAL for new construction: Short Plat/subdivision Ctia-ieielto UN"G-oda U.N./L5*No.ti (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 4k...4/✓( wAJQcvi0.4.B.- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 14-(5- 200 e-,-c-, 1.) --t T-t. IE GZ 9y2 '3 <br /> CITY STATE ZIP <br /> OWNER PHONE: t"-- 47.----1--14( I OWNER EMAIL: llG t tS 11 K i4d - GD, Wes' <br /> CONTRACTOR NAME: e ,y iso 11U IQ jT711( .) <br /> JJ <br /> ei, <br /> CONTRACTOR ADDRESS: STREEE�T!!% 52. gFILAitygt ell?i(1 ..-:7-c, <br /> ta <br /> cry g--)451./ pp1�t^pqi oy e.1.0(514 STATE ZIP <br /> 16 -"'....\\ <br /> CONTRACTOR PHONE: 4Q _ CjCi,u. 5.,11441 CONTRACTOR EMAIL: i g7 <br /> CONTRACTOR LICENSE#(REQUIRED): �yL,ARc8 ?Aar!OF EVERETT BUSINESS LICENSE#(REQU' ED),( <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR `,`OTHER(Please Specify) 9IJ6,43 <br /> CONTACT NAME: CONTACT PHONE: /7r'.J , —et .,.,,4C/ z <br /> � D F J L) CONTACT EMAIL: sfiI.- rnu\ mni c.o <br /> BUILDING PERMIT APPLICATIO <br /> Existing Use of Building: f- ILL' ( f.JGE Contract Price of Wor:$ tC,OteTh <br /> Proposed Use of Building: ,f-- ( J Heat Source: ❑Ga- DElectric A Other <br /> Building Type: `E FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: 2Commercial CI Industrial <br /> Type of Project: ❑New DAddition y&emodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> optic 12_4:01,A 1MoV7 C s f- car`I t-) 43(1.3G1, <br /> C 17E , om " �,I3 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): get � -"�/ <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn _Alteration Repair Type of Project: _New Addn _Alteration _Repair <br /> #of #of List of Fixtures List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures _ <br /> A/C-Air Handling Units Heat Pump 1 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 k 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 l the State Contractors Law 18.27 RCW and 296.200,4 WAC. <br /> City of Everett Official Use Only <br /> Owner/Authori Agent ignature Date (Revise. •/23/2016) <br />