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PERMIT APPLICATION. <br /> ,!...,..r..A 0 BUILDING I MECHANICAL I PLUMBING /SIGN /SPRINKLER / DEMOLITICI\) <br /> CITY OF EVERETT PERMIT SERVICES <br /> 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 /> Qk'ItvTorr IBlack Iuvla Only please) 0 ',OJECT SITIE IIIFOAMATIOIII <br /> i____ <br /> PROJECT SITE ADDRESS: 2 7 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> T— <br /> / . CONTACT I�l'FOI'EUEATION <br /> O NER NAM : ►t13 R c160U) TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Z t,t.l )2 ei f . 4/e <br /> Cm, it_vi/,t _ STATE Afj(' ZIP 20 / <br /> OWNER PHONE: y2( 5/ 7 7 OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: n,,, , �' / CONTACT PHONE: Gfz c�(/`_ a-&CC <br /> 6v 1`�"1/nOr' �R7f4(� �"(/ CONTACT EMAIL: 00✓►'�i n/nztitht i CZ/26/, +n <br /> BUILDING PERMIT APPLICATION /� �\ <br /> Existing Use of Building: Contract Price of Work: $ kUO. <br /> Proposed Use of Building: Heat Source: ,QGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ONew DAddition DRemodel ❑Repair DTI. ❑Sign DSprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> kadV)14 c CitSCMC41 AI? 611-S' giltiK/611.9s el gyee , <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 Unit Heater Bathtub -1 Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> 4 ,Gas Range Ducting Dishwasher Roof Drains <br /> r Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I No. of Heads I <br /> • <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 comp ith the State Contractors La 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> , F-13 -18 al <br /> 1 qbg-- o711 <br /> v 0 ner/Authon ture Date (Revised 9/23/2016) <br />