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• • <br /> PERMIT APPLICATION <br /> /411°P44:V1---a <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ved 01. <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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 7 7 /F I- i' W E'4"e'(e 3)/PROPERTY TAX#: :> 3 4 y 9-00o n 1700 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (( .6.e 110 Sa-y\C,L - - �y TENANT NAME(I <br /> ! <br /> OWNER MAILING ADDRESS: STREET 73'0 /�j-�1— ,4-(/.l ymmercial): <br /> CITY F1/�7 '� �� STATE W ZIP cir? 17) <br /> OWNER PHONE: 9 2 — �of (.03 pt3 OWNER EMAIL: plk-- 1 0,�,,,,, q y � �; I . (CONTRACTOR NAME: O(,*J/io <br /> CONTRACTOR ADDRESS: STREET 470S e #`'j e i l„ <br /> CITY .C•(-/1/ STATE 141 0_ ZIP (J— <br /> CONTRACTOR PHONE: �— 0V. �03 (pJ CONTRACTOR EMAIL: D�b2Sah2rP 1\a�mccry) <br /> V om <br /> y2 � J <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ,gI OWNER ❑CONTRACTOR ❑OTHER(Please Specify) .1 <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ge,5 t/4a^:-(-'/et I .) R-� Contract Price of Work:$, t:,iJ. �'0 <br /> Proposed Use of Building: 5- 2e'z;Atvrt! / Heat Source: OGas 18/Electric ❑Other <br /> Building Type: NiSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ONew kiAddition ❑Remodel ❑Repair ❑T.I. ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 9 L y 449 j <br /> will biz_ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> ,Type of Project: _New ,X Addn _Alteration _Repair Type of Project: New x 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 Urinal <br /> Gas Piping Boiler a Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> r Clothes Dryer Hookups Other: / Clothes Washer Medical Gas <br /> Range Hood / Water Heater Other: <br /> t. Exhaust Fan Sink(Sep/Ice/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 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the St to Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> z-W't L.../ ( <br /> Authorized Agent Signature Dafe (Revised 9/23/2016) <br /> 1 <br />