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0 PERMIT APPLICATION <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />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: 7,':5r0 COC. BY A U€ <br />I PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: CA TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET '9-7 a'-C r— A v� <br />Q <br />CITY �'.V �i-- STATE ZIP L <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: A 6 Sf Y <br />CONTRACTOR ADDRESS: STREET 1 �• �jQ �30 <br />Q <br />CITY �� C C.. U / STATE ZIP <br />CONTRACTOR PHONE: °P-0 S. a'd (0. S a (-? <br />EMAIL: cr _ j t7 v1 C � <br />����CONTTRACTOR <br />CONTRACTOR LICENSE #(REQUIRED): A c � ff --C ' r 22"fg PS <br />I CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): G �{ <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR MOTHER (Please Specif)) C-- <br />CONTACT NAME: C gA c <br />N/ 19(,SBJ� <br />CONTACT PHONE: <br />/�_Y <br />CONTACT EMAIL: �S/W f So ram! r' bc'l—« de's/� o . Co <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Kew r s — V kk" <br />Contract Price of Work: $ 00o <br />Proposed Use of Building: S p� (� <br />Heat Source: ❑Gas ❑Electric ❑Other <br />Building Type: ❑SFR-Detached EISFR-Attached Duplex ❑Multi -Family-# of Units: O'Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair LrT.I. []Sign []Sprinkler ❑Demolition []Change of Use <br />DESCRIPTION OF WORK: <br />A -ad 1,y700 O <br />to <br />ASSOCIATED BUILDING PERMIT # (if applicable): ►.� 1 !� ( S <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New Addn _Alteration _Repair <br />Type of Project: _New _Addn Alteration Repair <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />Lis 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 />( <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urin <br />Gas Piping <br />Boiler <br />*6 <br />Lavatory (Wash Basin) <br />nking Fountain <br />Water Heater <br />Refrigeration <br />Shower <br />Floor Drain <br />Gas Fireplac <br />Wood Stove <br />Kitchen Sink & Disposal <br />Z <br />Gre e Trap <br />Gas Ran <br />Ducting <br />Dishwasher <br />Roo rain <br />Cloth Dryer Hookups <br />Other: <br />Clothes Washer <br />i I G <br />RpKge Hood <br />Water Heater <br />r <br />xhaust Fan <br />Sink (Service/Mop/etc.) <br />Ot r: <br />SPRINKLER/ <br />SUPPRESSION <br />SYSTEM <br />Chemical or water <br />No. of Heads <br />ACKNOWLEDGEMENT.' l have reviewed this application and confirm the information contained herein is true and correct. WorfC 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. 1 am the owner, or l am authorized by the owner of this property to perform the work for which application is made, <br />and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Agent Signature <br />City of Everett Official Use Only <br />PERMIT # <br />07,1�.I -7I� <br />Date (Revised 912312016) <br />LW <br />C <br />