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0 PERMIT APPLICATION <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />OL 3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION 3A 5 f ZZ O I D Z <br />PROJECT SITE ADDRESS: jQ Z A)oA Qco uI w Ati ,� <br />PROPERTY TAX #: 2-05 14 D b ZO 3 7-0 <br />LEGAL for new construction: Short PlaUsubdivision _ Lot No.___.__.__ (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: ko l DeOe .'I,,en TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET 03 E`ckc or A c Z.o <br />CITY n tn":6 A STATE WA ZIP / L b <br />OWNER PHONE: 20 Z <br />OWNER EMAIL: 015A ociiD e4 , 1-eG- I <br />CONTRACTOR NAME: -7a <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: Vf OWNER ❑ CONTRACTOR OTHER (Please Specify) <br />CONTACT NAME: �- ,,pp <br />�i Soh N�?rS8/1 <br />CONTACT PHONE: <br />/l <br />CONTACT EMAIL: J�t�oiJ (� s�D� �et9e�U it t !/1t.L0 <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: <br />Contract Price of Work: $ (O �J �p to <br />/ / <br />Proposed Use of Building: 2'Z �rLtILL'efG��Gv� �,B�iLrf <br />Heat Source: ❑Gas Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex Multi -Family-# of Units: ;1- 0 Commercial [Industrial <br />Type of Project: ' ew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign []Sprinkler ❑Demolition []Change of Use <br />DESCRIPTION OF WORK: <br />S L-e-ap-LS e)q 6prc4--o <br />ASSOCIATED BUILDING PERMIT # (if applicable): 2 U <br />PLUMBING PERMIT APPLICATION <br />MECHANICAL <br />PERMIT APPLICATION <br />Type of Project: <br />_New _ Addn _Alteration <br />_Repair <br />Type of Project: _New _-Addn <br />_Alteration _Repair <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />A/C — Air Handling Units <br />Heat Pump <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />Kitchen Sink & Disposal <br />Grease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />Other: <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />Water Heater <br />Other. <br />Exhaust Fan <br />Sink (Service/Bar/Mop/etc.) <br />Other: <br />SPRINKLER <br />f SUPPRESSION <br />SYSTEM <br />Chemical or Water <br />No. of Heads <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 perrnit 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />r,/ City of Everett Official Use Only <br />PERM # <br />i o3 ►Z �Zot�'� <br />Owner/Authorized Ag@ ignature qate (Revised 9/23/201§}-------1 <br />I�� <br />