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OLT PERMIT APPLICATIOP <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 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) JJ PROJECT SITE INFORMATION i'A�( 1' <br /> PROJECT SITE ADDRESS: Lc' (a ti��.I l'l e ti A e- ..',';'--"e-fir t?5 +.6 PROPERTY TAX#: 00':-I I 1'-I OG OC)5)102_ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: e Y I L. A, 11 o I1) re-}-e en,I TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5022 11 -1-1.-) S-F 5 W <br /> CITY 11 l&P.I 1.-{--?0 STATE Y . A ZIP C71 "Is <br /> 7.� <br /> OWNER PHONE: (zoi. A.rx O - 101 C, OWNER EMAIL: h:-1I\i•-)('.4-e r7-,( Oi/-+-1,)C; k K. G..c'.) r Y" <br /> CONTRACTOR NAME: VI 1 L'\ 0 11(•_',r <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: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: i, 1 CONTACT PHONE: ( lo'Ut�) 33D - 10 i G <br /> HolIV 1 QT21'�j�'.(� CONTACT EMAIL: ISIDi1v F-'' ertjz�l0, ');.44- c;C) .t (:/t <br /> / G BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 1-- g. Contract Price of Work:$ <br /> Proposed Use ofyBIding: }- R. Heat Source: Q,Gas ❑Electric ❑Other <br /> Building Type: MSFR-Detached ❑SFR-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 /> 'VIeA -i x-i/u/e.-? I t-,hez roc_L. -1"1A-/(10tC )►� 47tA1 6.---11)(1 <br /> i e_ f <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 #of #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> •- -} ! A/C-Air Handling Units 3 Heat Pump _ Toilet 0 Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Q Unit Heater I Bathtub Ci Urinal <br /> 1 Gas Piping U Boiler _ Lavatory(Wash Basin) v Drinking Fountain <br /> Water Heater ( Refrigeration ; Shower Floor Drain <br /> L ,Gas Fireplace 0 Wood Stove i Kitchen Sink& Disposal Grease Trap <br /> C) Gas Range I Ducting Dishwasher Q, Roof Drains <br /> 1 Clothes Dryer Hookups Other: Clothes Washer i <br />