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0 PERM <br /> OFEVERETTIT APPERMPLICAIT TI �SERVICESOI� <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ DEMOLITION <br /> CITY <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: j5( -� ►7 ,1,tl -- PROPERTY TAX#:c1044„CCi '24/00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ] ] TiNfa TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 14 IIL ted_>( L0 0.3e, /� '/ <br /> tvot - CITY STATE �A- ZIP Gt X!LAC/ <br /> OWNER PHONE: Z1-1•� - OWNER EMAIL: km oltek( / ? �O 6 (V/-co,vr <br /> CONTRACTOR NAME: �l i t! <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 pOTHER(Please Specify) t f <br /> CONTACT NAME: CONTACT PHONE: (�,TA <j-_(G`KV2_ Sct��_ 4 1!`lhl CONTACT EMAIL: .�fddA t�lorou6 1,5 v1 ,li.4144, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: X(L. Contract Price of Work:$ '�, 1 O� '00 <br /> Proposed Use of Building: i12— Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi=Family4 of Units: DCommercial ❑Industrial <br /> Type of Project: ❑New prAddition DRemodel DRepair DT.I. ❑Sign DSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 4 l0 4 -6642 <br /> 0tT1L t <br /> ASSOCIATED BUILDING PERMIT#(if applicable): C � 1,O2 QY <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 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 I 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 co tate Co Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT [ ,-b12 tho izedgent Signature Date (Revised 9/23/2016) l <br />