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• <br /> /eff,A,4/---g PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN I 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: 32f`ef 4-ft , , 4 4/ , f/.(/ g/a. r PROPERTY TAX#: od e/29®7d VO 2 ff co <br /> LEGAL for new construction: Short Plat/subdivision Lot No.Zt/-7,(attach copy of long legal description) <br /> [[ CONTACT INFORMATION <br /> OWNER NAME: 32/7 toii41. /Z C._ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Po b ja f ,?/7 <br /> W4447 f vo to CITY !!C/G NIf 4 5 V 1 ll../ STATE1416^ ZIP %,"79 ei <br /> OWNER PHONE: C/7c.- Z 3` F3 7 7 OWNER EMAIL: <br /> CONTRACTOR NAME: e..)(4415C <br /> CONTRACTOR ADDRESS: 1 Zs3e0 fd LI \SICA V"C /1 + <br /> rrl C{`v,S V 1\l"e. crr 'OP 1 1 cg 3-1 1 STATE ZIP <br /> CONTRACTOR PHONE: 4 ZS--22.0^2-gS D CONTRACTOR EMAIL: ice UCn COr're 22 Q- y?a.lVoo 43. <br /> CONTRACTOR LICENSE#(REQUI (atiOin, Si OF EVERETT BUSINESS LICENSE#(REQUI D) <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR El OTHER(Please Specify) v <br /> CONTACT NAME: A CONTACT PHONE: I/77_ 23/, .5���-,y ? -17 <br /> $ fl'Jp�,ih , CONTACT EMAIL: /Pi^h JO Af'jiA„fi1"7r// C'e�BUILDING PERMIT APPLICATION <br /> Existing Use of Building: -sf,1 /� Contract Price of Work:$ ekQ, 01..7 p <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex IIMulti-Family-#of Units: 01 ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> r r k% c.ci.-- (k c S c.,c G Lb _-2. v v,-e- N o k,J c-k-c 4- ^qc. a.ct <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 #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 thorized 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 Stat tractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> n PE IT# <br /> .-2/-7 5 PE Z — 022' <br /> ri Agent Signature Date (Revised 9/23/2016) <br /> YZ <br />