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OLT PERMIT APPLICATI <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN , SPRINKLER I 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: I ((I!p 1, ZQ, ' Srt_ `= PROPERTY TAX#: ZSOe� A-co7196 <br /> LEGAL for new construction Short Plat/subdivision_ Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ''(ryc T-[-Ii(mil- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1 4 ( , 124— <_�rcC <br /> CITY e J TT..},1 STATE 1.4.,-(4- ZIP <br /> OWNER PHONE: 42,j 4 �J� 7 -2- OWNER EMAIL: <br /> f' <br /> CONTRACTOR NAME: ✓ ic...„,,, 1! , <br /> n,_ G.,, <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQ IRED). <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR r4 OTHER(Please Specify) -(c- ✓1, <br /> CONTACT NAME: CONTACT PHONE: +2_5- 8 `1_--7%( L <br /> J Ft` A-1, <.t 1— CONTACT EMAIL: le ,711.I II✓cSi '4/6o15 l'fZ Sk'K: <' c r <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building 5/Cie Contract Price of Work: fA, ACE) <br /> Proposed Use of Building' , / <br /> `e Heat Source: ,Gas ❑Electric DOther <br /> Building Type. DSFR-Detached ?lOSFR-Attached ❑Duplex DMulti-Family-#ofUnits DCommercial ❑Industrial <br /> Type of Project ❑New Addition pRemodel DRepair ❑T.I. DSign DSprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: /4.-b9 <br /> CEO h7r -rt '<�2l.Ot_ Z 7ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: 7, 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 2.- Toilet Backflow Preventer(Inside Bldg) <br /> / Forced Air Systems Unit Heater Z Bathtub Urinal <br /> / Gas Piping Boiler -3 Lavatory(Wash Basin) Drinking Fountain <br /> j Water Heater Refrigeration ( Shower Floor Drain <br /> / Gas Fireplace Wood Stove k 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 /> 3 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/am authorized by the owner of this property to perform the work for which application is made, <br /> and l c ply with the State Contractors Law 18 27 RCW and 296 200A WAC <br /> City of Everett Official Use Only <br /> j 1 7 PERMIT/#' 0 <br /> e/ z,_../ <br /> Owner/Authorized Agent Signature Dat (Revised 9/23/2016) <br /> \ J2 <br />