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44677- 4111 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 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: �._, ? .�C-Y1 L . PROPERTY TAX#: LSO 1 L- 0G-3 5 OCJ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: -; t i ' t ' ± �_ TENANT NAME(If Commercial): A 6 5Li,54-2 4A(..s <br /> OWNER MAILING ADDRESS: STREET 2_ L Z ' ') ' . <br /> • <br /> CITY _-_. L% e- STATE W Y ZIP ? 43 Z--o .. <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET ` <br /> CITY 12„e..,,,,�+'�--L�. STATE rN r� ZIP Lq G 0_ , , <br /> CONTRACTOR PHONE: -5 2-0 1- O0 5qp� CONTRACTOR EMAIL: '')V� � (-' 'bv- Cam',' , ; . <br /> CONTRACTOR LICENSE#(REQUIRED): (() 2 • 1 t - 0 l CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ,� L <br /> PRIMARY CONTACT: ❑ OWNER JD,CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L-Oto - ( 9 - / Z�-f <br /> CONTACT EMAIL:1 1. j? �� � ' Yam-t1-C,K.S . C a,U\ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: jA.12_!-k (tf Contract Price of Work: $ <br /> Proposed Use of Building: LA-7 S Li '7_4(,� -wtA,46, Heat Source: Gas DElectric DOther <br /> Building Type: ❑SFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: DCommercial 1:Industrial <br /> Type of Project: ❑New DAddition DRemodel DRepair ❑T.I. ❑Sign ❑Sprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: f u u ,-k-s D G G v'Y r i to eyr- <br /> proAD Ct l) ►,e),A-Lts 0 F v4vL`2-�E- (1�Lo.e�l�-� 5 f P�t4► 4-- p vve EL <br /> A a4-1 0 vim) ,(toes ► fJ , <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 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 /> Gas Range Ducting Dishwasher Roof Drains <br /> 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 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 /> J • <br /> 5 / ZS h-0 <br /> PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> qf" 1 <br />