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• PERMIT APPLICATION <br /> /1•10/ /---ABUILDING / 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 'Z ,. ltiert42Qe" 4I PROPERTY TAX#: 0 7c 11 I SGe 3d0 <br /> LEGAL for new construction: Short Plat/subdivision KW rive. N b Lot No.I gW-(attach copy of long legal description) Lam-S 4 3 <br /> +,/ , ` b14.01) <br /> ,, CONTACT INFORMATION <br /> F <br /> OWNER NAME: 4 (1W/C1 b �iQ pT NAME(If Commercial): <br /> ( � <br /> OWNER MAILING ADDRESS: STREET P.0.6vs. 241 <br /> CITY 14(1244A1131 STATE 4 ZIP RO o U3 <br /> OWNER PHONE: 4 '??2 &/ ( Z OWNER EMAIL: <br /> CONTRACTOR NAME: Off(,ki(. <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 0 CONTRACTOR VI OTHER(Please Specify) allig A&tmlir <br /> CONTACT NAME: <br /> � CONTACT PHONE: 42117 �74'G- 2.s-3a <br /> Discat P ►vI CONTACT EMAIL: D rA..L.Ni laiifFct e..... 4,1..ie..rsi <br /> BUILDING PERMIT APPLICATION '--k3 9 - <br /> Existing Use of Building: Contract Price of Work:$ <br /> c <br /> Proposed Use of Building: gvk bap&( Heat Source: ❑Gas ❑Electric $Other rzrA F t' <br /> Building Type: ❑SFR-Detached ❑SFR-Attached Iiiituplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION F WORK: <br /> )(N <br /> RuCc,B 4E14 pakex bpt e P Lc)T <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION_ <br /> Type of Project: ANew _ Addn _Alteration _Repair Type of Project: XNew _Addn _Alteration _Repair <br /> #of #of fist of Fixtures List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units . Heat Pump e? Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater t Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> 'L Water Heater Refrigeration Z Shower Floor Drain <br /> Gas Fireplace _ Wood Stove Z Kitchen Sink&Disposal Grease Trap <br /> Z/ Gas Range Ducting j.. Dishwasher Roof Drains <br /> 2 Clothes Dryer Hookups Other: 2 Clothes Washer Medical Gas <br /> Range Hood V Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> 145 Z <br /> INKLER �SJPPRESSION SYSTEM <br /> r 4,4 hemical or Witer I l Le I No.of Heads. 30 <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 I. ,. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Offi •-fore being a ho'ed 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 com. the ate Co tract. Law 18.27 RCW and 296.200A WAC. <br /> / City of Everett Official Use Only <br /> PERDAICAPE T QO� ......c. . ..-4.1Af riird d.. ..4 <br /> •w er/Authorized .gent Signature / AV Date (Revised 9/23/2016) <br />