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• PERMIT APPLICATION• <br /> BUILDING/MECHANICAL/ PLUMBING /SIGN/SPRINKLER/ DEMOLITION <br /> g77. - 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) p PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1 b Act 1 O t,I 5 6 tV crC Et 1044.1 2D2 PROPERTY TAX#: 5"Il 001034 00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (1,i it i V tA.6(j iol< TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET I aft to 7 P 1 S C. • <br /> CITY itA.P/1 eA71" STATE 14 A- ZIP /Q <br /> ti Lt <br /> OWNER PHONE: 1 .0S--3 st) OWNER EMAIL: G?19' ,GiK,./ ivic.o` LAD• t.x <br /> CONTRACTOR NAME. V w w r <br /> ..0e 0 (A£2- jJ <br /> CONTRACTOR A S: STREET CITY STATE ZIP ` 42 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: /n Vt) <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): -1 1/vv JJ ,� <br /> �— N <br /> PRIMARY CONTACT: RI OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> lJ,� <br /> CONTACT NAME: Lia,s-3 70- <br /> t(Ur.J LI P(A) ki ��t_ CONTACT EMAIL: Pp P C . k , ��7yV �. <br /> ` �' <br /> BUILDING PERMIT APPLICATION J <br /> Existing Use of Building:pr Ltv.i.c.,,rtj Cel 1 LI et, ..e. C/ ik)�Contract Price of Work $"" i O,e, 0 <br /> Proposed Use of Building: ?1^,3`r...4(� sf c1 o"c',,1)P)Heat Source: ) Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached %sFRR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: ❑New $Addition DRemodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:4 e(k' ,5 Cs 6- s b..... a cicui\n„ c ( l fv —S opt, C-e 1.,,,, <br /> 5 fie . <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 /> NC—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 1 Kitchen Sink&Disposal Grease Trap <br /> II Gas Range Ducting i Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> f Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/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 ly with the State Contractors Law 18.27 RCW and 296,200A WAC. <br /> City of Everett Official Use Only <br /> 1( 15 PERMI ( ^ Q(g _ co j <br /> Owner Authorized Agent Signature D e (Revised 9 23/2016) <br />