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PERMIT APPLICATIOis <br /> BUILDING. ECHANICAL/ PLUMBING /SIGNRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 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: 35"6/ tip/al el AA E'04(Ili 7T1 ' PROPERTY TAX#: 9o1.336 DDOOfC <br /> LEGAL for new construction: Short Plat/subdivision 1,7.0Z..— '0(5--0 D Lot No.. 3 (attach copy of long legal description) <br /> CO TACT INFORMATION <br /> OWNER NAME: e—o t„,/0„ e ,��/ 0,,,-,„.42.,JINANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET - ?..f a(/ gill IL sl--- <br /> CITY .0/44/`G# STATE WA ZIP ?'?z,eyQ <br /> OWNER PHONE: 4Z5 g 7 to //3 0 OWNER EMAIL: 6-12,,c/A6ec'� ,/4C�S i, Lied Y <br /> CONTRACTOR NAME: (qA <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: CONTACT PHONE: ii e76. /137) <br /> ,.,-, ,e4 CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> eo <br /> Existing Use of Building: Contract Price of Work:$_ ZC)(/)(°)Q <br /> Proposed Use of Building: .5-c Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: NSFR-Detached ❑SFR-Attached ['Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: New ❑Addition ❑Remodel ['Repair ❑T.I. ['Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Sr- te / '7107 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New _ Addn _Alteratio _Repair Type of Project: _New _Addn Alteration _Repair <br /> #ofList of Fixtures #of List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units _Heat Pump Toilet e Bldg) <br /> (Forced Air Systems Unit+teater- Bathtub 1 ttrirj—'- <br /> GasPiping Baiter-- Lavatory(Wash Basin) 7 -Brinkiin <br /> Water Heater / }Reffigorotien— Shower / •-IeerBre►irr- <br /> W as Fireplace lt>Wc06-640ve-- Kitchen Sink&Disposal / reaseTrap- <br /> 'Gas.�.arive ' / -8t,tAfhiy- Dishwasher / RocrDT3TRr <br /> Clothes Dryer Hookups / -Cather:- Clothes Washer / „Medical-Etas- <br /> Range Hood / - :- -r ^ -_ , I <br /> Exhaust Fan opf Sink(Service/Bar/Mop/etc.)- / er4-- <br /> SPitili :LER i SUPPRESSION SYSTEM <br /> Chemical or WaterHeads <br /> ACKNOWLEDGEMENT-1 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.•.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!comply with the State .ntractors Law 8. RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ' PERMIT#� L1 01- ^ l <br /> /z/� ✓, <br /> Owner/Authorized Agent Signature D to (Revised 9/23/2016) /� <br />