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JI.0 AE6 <br /> PERMIT 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 www.everettwa.gov/permits <br /> (Bone or lack Ink Only Please) P• <br /> __.. <br /> ®.DELT SITE INFOF':M'&TI®N <br /> PROJECT SITE ADDRESS: 22/7 f? f//l.e/ C, <br /> V2-. veY¢�� D <br /> i• �PROPERTYTAX#: f�Gey7697J 9oe-fee <br /> LEGAL for new construction: Short Plat/subdivision CGG <br /> v ✓ t`U /oLot No enI9(attach copy of long legal description) <br /> �tD ,^ p <br /> /; CONTACT I !FORMATI'•N <br /> TOWNER NAME: ?7/7 �G,e fC2✓ actio. GLC.- 1 / TENANT NAME(If Commercial): //,y <br /> OWNER MAILING ADDRESS: STREET ( G s-7( y/ff%% �( L/efr <br /> CITY Lx 4 k O.9 ✓ STATE h-S. LIP 5I, x.77 <br /> OWNER PHONE: 'lt9 G -Z Pie"— 77o I OWNER EMAIL: Gtr/(r , af - <br /> CONTRACTOR NAME: bear r( hg ad, - (soh f./,z cif o i L <br /> CONTRACTOR ADDRESS: STREET j'7 ) 7 £ Girl: 17, id)? /X-1/Q r1 7 <br /> CITY 12‘4//�T�j }7 h II STATE 4-4. ZIP 9J27 9 <br /> CONTRACTOR PHONE: 1--l13-- ?-7, _ 07 fS / CONTRACTOR EMAIL: A. c9c,h,R,? .ci , <br /> CONTRACTOR LICENSE#(REQUIRED): L G,4 b I r( J72.-07 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: D OWNER !I-CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:/ 1 CONTACT PHONE: Le gs,7 y —D 2f ' <br /> Oira,( frame CONTACT EMAIL: b *14- e -I?4 O n+��! G eh, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: - 11/41,-,41,;;1- `} ( Contract Price of Work:$ .A Or t)GU <br /> Proposed Use of Building: b .)9 X Heat Source: ($Gas El Electric DOther <br /> • <br /> Building Type: ❑SFR-Detached ❑SFR-Attached XiDuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: [gl1New DAddition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: _II <br /> rely dai?l& 2 ,rrrr/ <br /> (ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: Y 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 /> NC-Air Handling Units Heat Pump (p Toilet Backflow Preventer(Inside Bldg) <br /> 7. Forced Air Systems Unit Heater t{ Bathtub Urinal <br /> / Gas Piping Boiler b Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> 12.. Gas Fireplace Wood Stove Z Kitchen Sink&Disposal Grease Trap <br /> 2. Gas Range Ducting Z Dishwasher Roof Drains <br /> 1.. Clothes Dryer Hookups Other: Z Clothes Washer Medical Gas <br /> Z Range Hood Water Heater Other: <br /> xExhaust Fan 2 Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water ( No. of Heads I <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 /> PERMIT# <br /> Owner/Authorized A nt Signature Date (Revised 9/23/2016) <br />