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• PERMIT APPLICATIO• <br /> BUILDING/ MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> • arr 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: Z80 I, 9 Au 702— (}V6 e\SZO t7WI-PROPERTY TAX#: oQy 3 '(g6s-'goals <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: / \ <br /> M A�`�\ I1/4 \ (=eJ TENANT NAME(If* Commercial): <br /> OWNER MAILING ADDRESS: STREET $1 2:-. LID <br /> UJC L.1_ f e-U) <br /> CRY e�f e t` r <br /> si 1' ! STATE W 4 ZIP Yeeo3 <br /> OWNER PHONE: `7 25 — -j(t(j - q WO OWNER EMAIL:Merl u L\kr-43CP kid:.. Co/A <br /> CONTRACTOR NAME: Q tA)JV 0--_,. <br /> CONTRACTOR ADDRESS: STREET <br /> CRY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: RLOWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ke_S t fke V CG Contract Price of Work:$ SO t 000 <br /> Proposed Use of Building: '1-e_s\2,—'eu-eC— • Heat Source: 'IGas ['Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: OCommercial ❑Industrial <br /> Type of Project: ONew ❑Addition %emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ['Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> kitike ci 0 r v-ew� ( a v fort tkeNs 2`^S cf�eo Y. � ,'4"--a- A� , <br /> ASSOCIATED BUILDING PERMIT#(if applicable): V <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 List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump 3 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 4 Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater 2 Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove f Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting 1 Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: 1. Clothes Washer Medical Gas <br /> Range Hood - 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.lam the owner,or am authorized by the owner of this property to perform the work for which application is made, <br /> .a co ith th State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> RERMITS <br /> u ized Agent Signature D to (Revised 9/23/2016) 1�� <br />