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0 PERMIT APPLICATiba <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />4e7T 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 <br />PROJECT SITE ADDRESS: ZBot &1r4" A✓G <br />PROPERTY TAX #:00q$q 197 1 M'ICV <br />LEGAL for new construction: Short Plat/subdivision U -00 Lot No?2''Uo(attach copy of long legal description) <br />CONTACT INFORMATION <br />''- <br />OWNER NAME: C t&4 --UA'✓5 f"t> L LL TENANT NAME (If Commercial): 2CvV eV 6 ��ej%1� <br />OWNER MAILING ADDRESS: STREET -0 DyQ K 6�121 <br />', A A /, /yA /,, <br />- My ive � T STATE KOA ZIP Z194 <br />OWNER PHONE: WAV Q 6 <br />Ma - w i1, <br />CONTRACTOR NAME: G L <br />CONTRACTOR ADDRESS: STREET <br />CITY STATEbjA-ZIP <br />CONTRACTOR PHONE: �— T-3 CONTRACTOR EMAIL: �" VQ 6 <br />CONTRACTOR LICENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE #(REQ ED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify)�- <br />CONTACT NAME: r <br />f ` f <br />CONTACT PHONE: ft-6 .44'Z ,�j 7+ _ <br />CONTACT EMAIL: 30hNV�GC k �v L� MI •GOVY` <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: <br />Contract Price of Wo : $ <br />Proposed Use of Building: CFF- 'JHeat Source: ❑Ga ❑Electric ❑O <br />Building Type: ❑SFR-Detached ❑SFR-Attached []Duplex ❑Multi -Family-# of Units: IgGommercial ❑Industrial <br />Type of Project: ❑New ❑Addition I5Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />-�'P.�U1�1,�" (V'�V'Wh`eM"�'- U(U✓�--- O��rJGS� Y'P��'VUC?vU S� ��l�L4VU � G�V`e�. � �ff'L%Q 61i <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATIO <br />PLUMBING PERMIT APPLICATION <br />T e of Project: _New _ Addn V/Alteration epair <br />Type of Project: _New _Addn ✓ Alteration Repair <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtur <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />C <br />A/C —Air Handling Units <br />Heat Pump <br />Toilet <br />ckflow 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 & Dis sal <br />Grease Trap <br />Gas Range <br />G <br />Ducting <br />bQ'VVC1.t::' I., <br />Roof Drains <br />I <br />Clothes g6er Hookups <br />Other: <br />i <br />Clothes W er <br />Medical Gas <br />/ <br />Range ood <br />I <br />Water ater <br />Other: <br />l <br />ExfAst Fan <br />Si Service/Bar/Mop/etc.) <br />Other: <br />��e <br />RINKLER / SUPPRESSION <br />SYSTEM Jul <br />r�s <br />I <br />hemical or Water <br />INo. of Heads I <br />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 />PE T# ct <br />(Revised 912312016) <br />��Z <br />