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0 PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /ltRINKLER/ 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) 1 PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3 g \-0 %y— k AP J4 PROPERTY TAX#:00 _% \L\O \,‘O'2,' C) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: C CA✓W .'v\ \ '!.cA, TENANT NAME(If Commercial): vP P i1 <br /> OWNER MAILING ADDRESS: STREET 3 CQ` Q) CO\\O NV-e S kA:i C t Ea <br /> CITY v 0...Ar C." STATE V V —` ZIP C.? 2, 0 1 <br /> OWNER PHONE:t\) — '`L)--. 3 \,\ OWNER EMAIL: 9\A C •,\,^, 1( c' G'st A-vr,vo,\.tie_, <br /> CONTRACTOR NAME: OW C eV..., <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 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: ,e_v..-\ ( cz C„, CONTACT PHONE: �'�.'L'S_ \All-, "%i'3 \ <br /> CONTACT EMAIL: k c kti‘, 0.: lb 'kv.\C!k n <br /> BUILDING PERMIT APPLICATION <br /> 0-G <br /> Existing Use of Building: \ of -L ei s P_, Contract Price of rk: S 0 V <br /> Proposed Use of Building: Heat Source: Gas DElectric the 6."_e_ <br /> Building Type: DSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of nits: Com cial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel I}IRepair ❑TA. ❑Sign ❑Spr ❑Dem ❑Change of Use <br /> DESCRIPTION OF WORK: C " T ArJ \ Q 1. „L0% S <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 #of #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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 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 WAG. <br /> City of Everett Official Use Only <br /> P MIT# <br /> " ArV Ait C � I� W )Owner/Authorized Agent Signature Da\\. 1 (Revised 9/23/2016) <br /> T2 <br />