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OrEIT PERMIT APPLICATION BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS:77 Q 1 vae St,1 U`�✓ -I�-I gv e PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: 5e.91 Q LLarves A IY\a pa ykili(?ZTENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 0 Iiblen ' , CITY JQ'J STATE 1 A 1A, IR dlg' 3-0 OWNER PHONE: �32r-61.C) --7 DOWNER EMAIL: S�((A‘(� • )1.cGiiVYYy GS .�\S-g3�• cowl CONTRACTOR NAME: C L(.) &I CV CONTRACTOR ADDRESS: STREET 77O( 1y V' 53A- CITY Eve," STATE LA!A. ZIP �03 CONTRACTOR PHONE: ((r25) 8-9 9 CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): • PRIMARY CONTACT: OWNER CONTRACTOR 0 OTHER(Please Specify CONTACTNAME: CONTACT PHONE: C.r2,5)32) -cc7 Co,V/l(, CONTACT EMAIL: e,(i\(_,, 1'av . 2r_,iselima„,I-cAn., BUILDING PERMIT APPLICATION Existing Use of Building: I 4Itr 10 pu sorn Contract Price of Work:$ Proposed Use of Building: I\AA Our,)) I06 sl 1P Heat Source: ❑Gas DElectric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units:_ ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition El Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK. ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn _Alteration Repair Type of Project: _New _Addn Alteration _Repair #of #of List of Fixtures List of Fixtures #°f List of Fixtures #°f List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER/SUPPRESSION SYSTEM ,Chemical or Water I No. of Heads 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 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 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, and I comply with the State Contractors Law 18. W and 296.200A WAC. 1 City of Everett Official Use Only �� PERMIT# 1 t /1 I SC5 1 ) Owner/Authorized Agent Si_nature ate (Revised 9/23/2016) 1z-