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• PERMIT APPLICATION• <br /> BUILDING /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 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: J t 117 Si 1CA3 PROPERTY TAX#: zed.Si 1 003o2.Sz <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 4J 6 O DE, fr j 4 L(j uA-LL CTENANT NAME(If Commercial): 11,10pal_ I Ome" <br /> OWNER MAILING ADDRESS: STREET -744.2k, s,,L 23 ' sr. Su - - 2.6 <br /> CITY ! r fu _ , S STATE ( ZIP <br /> OWNER PHONE: C- 14 - 8('2-2 OWNER EMAIL: 'v_..r E GLieprr r &mit <br /> CONTRACTOR NAME: RAI ST.U(..�„) RES L C, <br /> CONTRACTOR ADDRESS: STREET '7,4 ¶ Z1'� Srt`= ��j2.6 <br /> CITY J A CILL j.r- — 3 L.A" STATE Lk.)ft- ZIP ci 60* <br /> CONTRACTOR PHONE: I CONTRACTOR EMAIL: (,fie,. pie A(e <br /> CONTRACTOR LICENSE RE UIRED: CC1CITY OF EVERETTU LIE B CI j V 1 <br /> Q � ? NSE#REQU RED: <br /> PRIMARY CONTACT: ❑OWNER lid—CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: ,� CONTACT PHONE: f/2S`--2 _ 66 2.c <br /> e r p�L , 7 b ..„ CONTACT EMAIL: Ch . __ `CP cCi I .c/I <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ $2-Os COO <br /> Proposed Use of Building: Heat Source: OGas RSElectric ❑Other <br /> Building Type: ❑SFR-Detached OSFR-Attached ❑Duplex 0Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: p.New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: N STI��u.- 1�0tA") Mr• vc ,.Xv��� #gAtE <br /> r�- Ex isms en s� <br /> ,� tto ,z p -�- 6..44 of <br /> ASSOCIATED BUILDING PERMIT#(if applicable): A-U* U I si E P S f <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 /> A/C—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/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 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> I� iw 23 <br /> Ow Authorized Agent S gn ure Date (Revised 9/23/2016) <br />