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4reTT 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1 t Ck(` ve . PROPERTY TAX#:A'4' . i- \'2- <br /> c-A- C'c <br /> LEGAL for new construction: Short Plat/subdivision _ Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> � <br /> f <br /> OWNER NAME: ,��1 f Oil -- IN) ).0'1\1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 4 L <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: f'(;%Il.ti6-- C" tfv ,: .-)-- 561044_ co- <br /> _ <br /> , <br /> CONTRACTOR ADDRESS: STREET <br /> l 6P( <br /> CITY <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: ' IS A-764, <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVI mlr. 8 4. sf $1{--1 693. <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) Lz E -7 '7-1 S f 0 fw, <br /> CONTACT NAME: CONTACT PHONE: (4 <br /> l -okt_) V VIKL CONTACT EMAIL: <br /> 1 <br /> BUILDING PERMIT APPLICATII <br /> Existing Use of Building: iC 1 n03(11 Contract Price of VI <br /> Proposed Use of Building: V - L k 1-al(At. Heat Source: ❑G <br /> Building Type: G,IR-Detached ❑SFR-Attached ❑Duplex 0Multi-Family-#of Unite <br /> Type of Project: ONew 131M ition ❑Remodel ❑Repair ❑T.I. ❑Sign OSprink <br /> DESCRIPTION OF WORK: <br /> F Zj AP91.1-l'. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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 #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump ea_ Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater l Bathtub Urinal <br /> 3 Gas Piping Boiler _ 3 Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Q. 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 /> Q. 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 /> p4" <br /> ° PERMIT 1f6OJOwner/Author Agent Signature Date (Revised 9/23/2016) <br /> Z <br />