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811118..08f'<NC; 1 (-I._hjili*V:B l N / SIGN / S V'RONKL(_.E R I DE.iAn N <br /> CITY OF 1-VE--RE:(-I PE=RMI I 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 /> (Blare or Black Ink Only Please) PF;OJ[ C-u SITE ONIFORMATIOR7 ---_� <br /> PROJECT SITE ADDRESS:J c.rj 2/ /9 147 ,(%. c�', Mu./LPROPERTY TAX#: rL a'ofZ , zaps�O <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION - <br /> TENANT NAME(If Commercial): <br /> DOWNER NAME: (y>P/V� /�.v/�J e� ?`/�/� ftlolj ) <br /> OWNER MAILING ADDRESS: STREET /6301- J F 7 cf7i2 a'e7, <br /> CRY �±Gj4 V'S' STATES I"i A- ZIP e,(,2' <br /> OWNER PHONE: r OWNER EMAIL: t t rl ct� <br /> :CONTRACTOR NAME: �j _17, �J <br /> CONTRACTOR ADDRESS: STREET <br /> Coy STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> !CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR Z. STHER(Please Specify) A_VZ. J_( c <br /> CONTACT NAME: j�ass �-��-,�,� s CONTACT PHONE: C t 59 Z i'Z - 2 I s.3 <br /> 11 <br /> /a c l-tl ' -C7'uTZ� CONTACT EMAIL: r^logs" (2Ct,t-cti-.f_ci-c,re_ L.e <br /> wt <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: S t -,S (�C Ike- f gy <br /> h t" pi-e H t, t . Contract Price of Work: $ <br /> Proposed Use of Building: T o Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ='t.FR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> w( (iJ n t t D ( p- -�.♦-t v -f t j <br /> ASSOCIATED BUILDING PERMIT#(if applicable): i% <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT A PLICATION <br /> Type of Project: New Addn Alteration Repair Type of Project: New Addn Alteration Repair <br /> #of #of #of List of Fixtures List of Fixtures List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump 'L Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater ( Bathtub Urinal <br /> Gas Piping Boiler -2 Lavatory(Wash Basin) Drinking Fountain <br /> IWater Heater Refrigeration I 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 I Water Heater Other: <br /> 3 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> OASO <br /> Owner/Aut orized Agent Signatu'e Date (Revised 9/23/2.016) <br /> J f� <br />