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PERMITOFEVERETT APPLICATIONPERMITSERVICES <br /> • <br /> ,,�,,�- BUILDING/MECHANICAL/ PLUMBING/SIGN /SPRINKLER 1 DEMOLITION <br /> .7 `y CITY- 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 j(E)everetteps@everettwa.gn„,.r,,. .everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION! "'�� <br /> PROJECT SITE ADDRESS: /%/49 Gf tiro 4-/i PROPERTY TAX#:0 O%f c- -j j me,0 o 0 <br /> LEGAL for new construction: Short Platlsubdivision be- -3 f( Lot No YO//'(attach copy of long legal description) <br /> CONTACT.INFORMATION <br /> OWNER NAME: GAG/ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /e7/4, rLi!`-z 4CJ x _ Pt-t.' � <br /> CITY /7_ ,.4Q r STATE 9 7 <br /> A ZIP L / / <br /> OWNER PHONE: L7/Z f- ye/y 99n 3 OWNER EMAIL: Z_,/L yc i/C G/l am/t. , <br /> CONTRACTOR NAME: / <br /> CONTRACTOR ADDRESS: STREET Iv <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR OTHER(Please Specify) /0J'r <br /> CONTACT NAME: "Aq,z g- /#f 0i- CONTACT PHONE: 6Zr- , 3 yr c 3 2 <br /> CONTACT EMAIL: /f f j J,G/i/yf l,£�V 6, 'At -£z' i <br /> BUILDING PERMIT APPLICATION ,yam a d'I <br /> Existing Use of Building: rn <br /> —�jo a-� Contract Price of Work:$ -e 4 D b <br /> Proposed Use of Building: Heat Source: ❑Gas 1irdectric El Other <br /> Building Type: DSFR-Detached ❑SFR-Attached pgkiplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: lew DAddition ❑Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler ODemolition El Change of Use <br /> DESCRIPTION OF WORK: /Zx it <br /> ASSOCIATED BUILDING PERMIT#(if applicable): VO 1i O " O e?) <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 <br /> Fixtures List of Fixtures #of List of Fixtures #of Fixtures <br /> Fixtures Fixtures <br /> NC-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 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!co m•ly with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City off Everett Official Use <br /> e/Only <br /> �� F 2 - /'a -/ PER-6(A 11 � 010 <br /> O h• iz= �nt Signs ur — Date (Revised 9/23/2016) <br />