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PERMIT APPLIC <br /> OIL BUILDING ECHANICAL I PLUMBING I SIGN RINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 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: 4 909 IQARBECK RD PROPERTY TAX#:OOV/7eco'QD2o2 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: PeTie fTF,.de-41.4/GyE:4•14 , TENANT NAME (If Commercial): 0/j� <br /> OWNER MAILING ADDRESSPIJ$TREET /J`2m0 .5P��� $ <br /> �/ CITY �/wgG/S� STATE a/o /� ZIP rd296 <br /> OWNER PHONE: 7 Z,S y2Z 6..�.�9 OWNER EMAIL: ,fie%e/e ,f%G/o(� Cpmcerlj:/Je)" <br /> CONTRACTOR NAME: ®wy6-4. <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: 0 OWNER ❑ CONTRACTOR IZOTHER(Please Specify) O9$d 4, q <br /> CONTACT NAME: ),:41xov .ry,490X,eyA CONTACT PHONE: 206.2 s4) 7.3Z9 <br /> r./ y/ __- CONTACT EMAIL: /5:4Qq IodP)( w�Pa-40a COS <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: — Contract Price of Work: $ 'fe•►r2• DOO <br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other <br /> Building Type: ❑SFR-Detached XSFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: • New ❑Addition 0 Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ,Qv/kp Zs 'gy /YO! 'i hive' Q/�f�i�fEit/j' Az-ri-4-cm-ece <br /> e <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: ANew _ Addn _Alteration _Repair Type of Project: X New _Addn _Alteration air <br /> Fi to f List of Fixtures Fixtures Lis Fixtures Fixtures List of Fixtures Fixtures ist of Fixtures <br /> -Air Handling Units eat Pump di/ Toil ckflow Preventer(Inside Bldg) <br /> / Forc-• kir Systems Unit Heater 3 Bathtub Urinal <br /> Gas Pipin• Boiler Lavatory(Wash 'n) Drinking Fountain <br /> ! Water Heater Refrigeration ,3 Shower Floor Drain <br /> Gas Fireplace Wood Stove / Kitchen Sink posal Grease Trap <br /> Gas Range Ducting I Dishwas Roof Drains <br /> / Clothes er Hookups Other: /' Clo Washer ical Gas <br /> Rar:• Hood / ater Heater Othe . <br /> haust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTE <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 /> PERMI <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />