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0 PERMIT APPLICATIO• <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ign". 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 /> 2 �'C <br /> PROJECT SITE ADDRESS:2- 2 G v aiA,c1� A i-e e(.e ,(/NA- PROPERTY TAX#: Tt 3 91- 83— 02 (-000 Z <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: J j11 cJ L. Karl y /Sz4wvlb 147ENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 222 G raM,C! f-V+_ q <br /> CITY Gv-e l(�- STATE V ZIP ,(�(j <br /> 2_.D/ <br /> OWNER PHONE: L-j2.7 5 3 - O 5 55 OWNER EMAIL: T L 0 I-ktY' `` 1@ HON }Cam <br /> CONTRACTOR NAME: —Day l cL LL t-\-&Y d 1� <br /> CONTRACTOR ADDRESS: STREET S 61 /\ (� <br /> CITY b° v STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: WWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT I NAME lei CONTACT PHONE: l�Zs 5-83--0 j S s <br /> aV is <br /> I V CONTACT EMAIL: )t. 14-curty a A oi-rn,a4, , co yvt <br /> BUILDING PERMIT APPLICATION a <br /> Existing Use of Building: Contract Price of Work:$ 'O t SoO <br /> Proposed Use of Building: Heat Source: ❑Gas DElectlfc DOther <br /> Building Type: DSFR-Detached ❑SFR-Attached ODuplex DMulti-Family4 of Units: DCommercial ❑Industrial <br /> Type of Project: ❑New DAddition XRemodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition DChange of Use <br /> DESCRIPTION OF WORK: j1i::c ' Q�ih5\ Q0A1_ovl Oc ov LSAS 6 ,,,,„„..„,1 <br /> car-e. e a�� t o,n a� L i v ty s Gz , 5P o 4(6f+ <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 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 / Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration t Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal ' Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> I Exhaust Fan / Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Chemical or Water I 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 Contractors Law 18.27 RCW and 296,200A WAC. <br /> City of Everett Official Use Only <br /> PEWIT# <br /> PIJt'gort - <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />