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llPERMIT APPLICATI <br /> BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> 440 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:// ," 675% , /?//t/ez /2/1.,`'b- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: i9/G' EVE -i7-- TENANT NAME(If Commercial): �- '/YC/e it//41WAII"- <br /> OWNER <br /> AII"- <br /> OWNER MAILING ADDRESS: STREET /a e75 �T/Z, _FJ-S-/i4t A/ ‘.1.4/ y 5-L//T6 7 ' ' �, <br /> CITY E i/Ej2 E/r STATE /�//t ZIP `,e / <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME / �� j C � ._5- 1-673 F—/h'L= /'/2d 7 7"/04/ <br /> CONTRACTOR ADDRESS: STREET / /47la A/5 yjs 7// STjQ��� //f(//J-+ /p <br /> CITY /eCD/7OA/0 STATE "(v /it ZIP <br /> CONTRACTOR PHONE: y25- • gsy/ rice' CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): fl/' 5 T C5 /_/j‘., A:- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 07C% ✓-,j j <br /> PRIMARY CONTACT: 0 OWNER ,CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ,x05,. Sj'/, /jj p <br /> X,oA//I/ A CONTACT EMAIL: Ar ',eve?A.-& ,sF� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: j17/ /2/1= Contract Price of Work: $ /. 7 ,./ ' <br /> Proposed Use of Building: A7/44-/e i Heat Source: EGas 0 Electric Daher <br /> Building Type: ❑SFR-Detached ❑SFR-Attached 0 Duplex DMulti-Family-#of Units: DCommercial 0 Industrial <br /> Type of Project: ❑New DAddition 0 Remodel 0 Repair ❑T.I. ❑Sign , Sprinkler 0 Demolition DChange of Use <br /> DESCRIPTION OF WORK: <br /> /4:74e6:- - /- 'E"v & .5->K5 7 —7 /.",/66=.02 e--"Q- I-'1y / <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 #of <br /> List of Fixtures #of List of Fixtures 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&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 /> Number 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 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contrac.rs Law 18.27 RCW and 296.200A WAC. <br /> / City of Everett Official Use Only <br /> PERMIT# <br /> /14ZZo/7 ��(16 ( -- CD <br /> Owner/Authorized Agent Signature Date (Revised 9/23/20 6) <br />