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• PERMIT APPLICATION • <br /> BUILDING /MECHANICAL/PLUMBING /SIGN/ SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 4477. 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: ?_7_7_7_ /-i1J1/ifcikeit„,,,_ PROPERTY TAX#: ( ) 5'l60 aoZ l <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: jL.),)1 6ZIent(J i TENANT NAME(If Commercial): �"'"'-'—' <br /> OWNER MAILING ADDRESS: STREET? fq LN) AliP If.te_. <br /> MYD <br /> (} IAA <br /> -A-- ZIP <br /> OWNER PHONE: (12-5-- 9/3-C� ll n OWNER? EMAIL: lYic9 � kjotycJ, ,(�Z <br /> CONTRACTOR NAME: U:t.[d ('ekuat7'c.-t'/r`.5 `. and s �J <br /> CONTRACTOR ADDRESS: STREET a / j(1 �t <br /> CITY cot,p -4 STATE L(,A ZIP 2,(�Y, <br /> CONTRACTOR PHONE:f/j t,/. '- 6 c) CONTRACTOR EMAIL: dour t om Il V vt.1.-rr— - C'es--A-,- <br /> CONTRACTOR LICENSE#(REQUIRED): 1-4/G if(J C- gtCP L,F CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5-3a2.( <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTAC ME: CONTACT PHONE: c 3i`3 -jp O 3 v <br /> o <br /> vl7 L�ZCONTACT EMAIL: airhw 1A1,-`� t y^C <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building F R. Contract Price of Work:$ f <br /> Proposed Use of Building: l F1).- Heat Source: as ,lectric DOther <br /> Building Type: JigSFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: El New Addition DRemodel Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK ❑ r <br /> ,62/ <br /> -e k <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 List of Fixtures #of List of Fixtures #of 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 q Unit Heater Bathtub Urinal <br /> 2, Gas Piping Boiler i Lavatory(Wash Basin) Drinking Fountain <br /> f Water Heater Refrigeration / Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> i Clothes Dryer Hookups Other: 1 Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> `- Exhaust Fan 1 Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water ' 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.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 Contra rs Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT#3 V b ^ DOA <br /> Owne uthorized Agent Signature Dat (Revised 9/23/2016) 1 <br />