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® PERMIT APPLICATION <br /> BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> fill g CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> ? <br /> PROJECT SITE ADDRESS: Jjb(v [,AF.61.n1V J <br /> T 7 i. PROPERTY TAX#: OO 4(p1 10O30 MOO <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1A'(i, Q W c' LT Or L(.(.. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET \ O1 1 3e.0 �vE N€ <br /> CITY 'CJ 6A%,t7 STATE VaA ZIP 11 21 1 <br /> OWNER PHONE: OWNER EMAIL: RTE912-0QE.,'tItSLLG@6MAIL.GOf"I <br /> CONTRACTOR NAME: OI"Jr, (Gg.--- <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: n J <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> .PRIMARY CONTACT: 0 OWNER ❑ CONTRACTOR ❑OTHER(Please Specify)A:MA(Ar11;( T71S f 6 JIt--- . <br /> CONTACT NAME: A(,E)C ScOFfE(,9 yr,F CONTACT PHONE: 1,0(p-L(32- I I I <br /> CONTACT EMAIL: ,GIC.@,1 oe.s.LOM <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: SF __. Contract Price of Work: $ 3Ot 000 , <br /> Proposed Use of Building: �7F?..., Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: DSFR-Detached 6::ISFR-Attached ❑Duplex ❑Multi-Family-#of Units: OCommercial ❑Industrial <br /> Type of Project: ❑New EAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: - M.-isoto6,4_, tkooc,, <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 <br /> List of Fixtures #of List of Fixtures #of List of Fixtures 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 E Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater - j Refrigeration Shower Floor Drain <br /> Gas Fireplace _ Wood Stove 1 Kitchen Sink& Disposal Grease Trap <br /> Gas Range Ducting Dishwasher _ Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> - <br /> I 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:l 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 WAC. <br /> City of Everett Official Use Only <br /> V-.2 <br /> PERMIT#N. 3<<',(`, cAt) 1104- Boa <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> 12 <br />