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• PERMIT APPLICATION • <br /> BUILDING/MECHANICAL I PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT.WA 98201 <br /> (PI425-257-8810 FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> {Btue or Blame ink linty Pleaaej PRt3 ECT 1rE INFORMATION -r... <br /> PROJECT SITE ADDRESS: Z.-501,' .4.5f.10.? S+ 7/Gr0;1-y C)j� PROPERTY TAX#: cis-7joo3°j'fO <br /> LEGAL for new construrtinn: Short PlaUsubdivision Lot No (attach copy of long legal description) <br /> CONTACT INFORMATIOi�I <br /> OWNER NAME: fr,r TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2-5 0.6 ,S -A .{-� 6te(z i i, �,✓/ )) <br /> �!TY �r',•d-�}" STATE W� 21a <br /> OWNER PHONE://6/4V OWNER EMAIL: <br /> CONTRACTOR NAME:G14/hGl� 7'6 <br /> CONTRACTOR ADDRESS: STREET <br /> Cr? STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR OTHER(Please Specify)�1 <br /> CONTACT NAME:2c,1 I7 4, CONTACT PHONE:J 4i.5 / i <br /> / ✓ CONTACT EMAIL: i- j (;),/" Z <br /> BIIIl.D1N PERMIT APPLI `4,,,T 1 <br /> Existing Use of Building: /741M,r„ Contract Price o ork:$ <br /> Proposed Use of Building: Aj by C, Heat Source: 0 <br /> Building Type:AZSFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ) Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: �1oY' 4+6r-cl.j`1c34(.,$ iC!$t)l S , p 1- �A`t5�f;lA, kj r <br /> .i,qq 7c $e sen c' i _ ,?f Place, k..)Ad s uS doors OU d" C�R.i a'. A-c.Z s <br /> z:.c�ors, Ca�'Ldn, tito,.,e xtae eie4-cc'f-a rS 5`' �xli a�s t F,A5- -� dr. f ccdc��t C a t o <br /> ASSOCIATED BUILDING PERMIT#(if applicable): /v e "41" ' G =e4.. (Pr/py-j-- ii/(,)I x4.- Z <br /> IUIECHANtCAL PERMIT A//PE►Lrk,E`ATI#OiN PLUMifiNG PERMIT'AP II;ATLON <br /> Type of Project: New Addn 1✓Alteration _Repair Type of Project:_New _Addn Alteration _Repair <br /> #of List of Fixtures #°f List of Fixtures #°f 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 I Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> f Water Heater Refrigeration / Shower Floor Drain <br /> Gas Fireplace Wood Stove St r Kitchen Sink&Disposal Grease Trap <br /> Gas Range j Ducting Dishwasher Roof Drains <br /> f Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood f Water Heater Other: <br /> -Z, Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER 1 SUPPRESSION SYSTEM <br /> 'Chemical or Water I INo.of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm the information contained herein is true and correct.Work done pornhost to this permit must comply with <br /> rent f deial.state,and local law.The granring a permit only authorizes app"oved work and no deviations therefrom.Deviations thus!fist bo authorized in writing from the <br /> Building Official before being authorized under arty sucumslance.1 am the owner.or!am authorzed by the owner of this pniperty to perform the work for which apphcatdn is made. <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAD. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> ''`1-f;. 6 lam/ J1✓jj <br /> OwnerA'tof6orized Agent Signature ti Date ✓/ / (Revised 9/23;2018) <br /> 2 � 2 <br />