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PERMIT APPLICATIOF <br /> Oren_ <br /> BUILDIN.:. i 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: 1332 PROPERTY TAX#: Op4 36Pa241 0 <br /> LEGAL for new construction: Short Plat/subdivision e%/E- .�c1T IY.1 Q- Lot No.N1146 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 112.,p,G.-1 3 TINIk. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Vb-b2. Q.V QAg <br /> CITY STATE \t] ZIP ° 2_O I <br /> OWNER PHONE: 4p, 1.gGt t 4'}-{, OWNER EMAIL: 6ILSoty, (it'?b L. Coth <br /> CONTRACTOR NAME: ov..NNESL <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: DOWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: -I.�GY Ett�SoN CONTACT PHONE: 42J }cam 5g46 <br /> CONTACT EMAIL: C�ILSoaa (*MAI)...•C'z2.141 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Cd.Qpfo£ ' LNR--90t.-r Contract Price of Work: $ Z5,aszC' <br /> Proposed Use of Building: C. .taa.�.Catc Heat Source: ❑Gas ❑Electric ®Other NiciAt <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex DMulti-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: IiZNew DAddition ❑Remodel ❑Repair DTI. ❑Sign ❑Sprinkler VDernolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ptFMb cmt-0 tav40 Gam.s=Po2 r. G 0+.15T7.-1.UC"C' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Re..it Type of Project: _New _Addn _Alteration Repair <br /> #of #of List of Fixtures Lis .f Fixtures #cf List of Fixtures #°f of Fixtures <br /> Fixtures Fixtures Fixtures Fixt res <br /> A/C—Air Handling Units • -at Pump Toilet Bac w Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub oral <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 Ho'•ups Other: Clothes Washer Medical Gas <br /> Range Hood \ Water Heater Other: <br /> Exhaust Far Sink(Serv. /Bar/Mop/etc.) Other: <br /> SPRI LER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> -- <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!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT ri ) o1Pl <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> I <br />