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PERMIT APPLICATIO` <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> 477" <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 jPlease) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: l V 3 -f'1lc 5tteQJT ork.At, ,ZZO PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: A0O1/\ ru1v t U SVUJYt 2- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREETyy I V Aka W S1 <br /> CITY STATE i h ZIP CN/ Z3 <br /> OWNER PHONE:(Lf2 ) 343-- 7s 8 OWNER EMAIL: <br /> CONTRACTOR NAME: 0 Al'Ai <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 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> .p ty.. S P J- -'7 . CONTACT PHONE:(742,J.) 319- I(.01-jq <br /> K�C�C�I S\Nu — CONTACT EMAIL: v....a c1 S V\ t 2- @ jM0-4) .COYV <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: yrtivvo YZS�d C3 ,_ Contract Price of Work:$ <br /> Proposed Use of Building: Kt YQ,St&LW.L) Heat Source:)as DElectric ❑Other <br /> Building Type:-XFR-Detac ed ❑SFR- ttached ❑Duplex DMulti-Family4 of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New jfkiligkee j4emodel DRepair DTI. ❑Sign ❑Sprinkler ❑Demolition DChange of Use <br /> DESCRIPTION OF WORK: matmtv14n s t - 9 OS rn <br /> l uolto(in <br /> k,�-k IV \ �1 (}� \�1 oYY�9-�;� L[��1 N(£UU t4-€ Riot-vs A o ithweAvKicd <br /> 'czw1) <br /> Td'G ASSOCIATED BUILDI PERMIT#(if applicable): ( S+&.. , (S <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 /> qi°1'e. &V)4(41(.. 4/611 ,‘Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> Z <br />