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OLT 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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> 98�3 <br /> PROJECT SITE ADDRESS: f I IC) cC�l F.3y AVE J' �T ` PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: lCsl t SGA tit Gtz.A -ro TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Co 11O'cc =L >' "SO t <br /> CITY k�`e `r` STATE NvPT ZIP g 2O 3 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: O <br /> `fi <br /> CONTRACTOR ADDRESS: STREET -=y 7RA C>tt VA 171-\ Q� <br /> CITY r� TATE �+"r ZIP ll <br /> CONTRACTOR PHON 7'F'� � — htT4CTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUI ED): CITY OF EVERETT BUSINESS LICENSE#(REQU D): <br /> PRIMARY CONTACT: %OWNER ❑CONTRACTOR ❑OTH ease Specify) <br /> CONTACT NAME: CONTACT PHONE: -6LGZC( - <br /> "ail- C(S G0 6 F,-2-" CONTACT EMAIL: be,Zg f'a®cpritcLr z , j <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ " 2,ODO• — <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> S4:edrq I e' 1/1/1/Ulq&J <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 #°f List of Fixtures #°f List of Fixtures #°f 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 /> PERMIT <br /> 1C Al) btA—e q <br /> Ow Ier/Authorized Agent'it:ture Date (Revised 9/23/2016) t <br />