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J PERMIT APPLICATIO BUILDING4IPIECHANICAL/ PLUMBING / SIGN RINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Blaik Ink; nlX Please); PROJECT SITE INFORMATION PROJECT SITE ADDRESS 3 CI C( l /,,, S'-71' }- gc??, j PROPERTY TAX#:co j /j aSG 77,0l/G d LEGAL for new construction: Short Plat/subdivision Lot No. (at_:__tagh copy of long legal description) CONTACT INFORMATION `' OWNER NAME: Gil) pp-G��j��-/- L, �/`,„o- L -CTENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET Z" SC>Ci' y%.__J S 4- CITY 51 L?'-1-- STATE ZIP ,(S?7�Q l OWNER PHONE: e-ZS— 'zZ 5 7-5-7 OWNER EMAIL: /A,('o 0- `Il k} `.- rOT it yC1 rou r,�p!'L` , CONTRACTOR NAME:0j�",e� °*- 1 CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR -MOTHER(Please Specify) )r.(r ,7h4` CONTACT NAME d, / /.)�2'� ), CONTACT PHONE: i(36- -L5 1 j) CONTACT EMAIL:(i0 ,/ 0/ x,-,,,,,.2. ,,,s . C,r), BUILDING PERMIT APPLICATION`>' Existing Use of Building: /? 4,(1,011;ti. I Contract Price of Work:$ 7/2, VC,0 I Proposed Use of Building: Heat Source: ❑Gas pElectric ❑Other Building Type: EISFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: _ ❑Commercial El Industrial Type of Project: ONew DAddition ®Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK:--- -1-GO'Ic, l.f-CJc...") 7c -/a 6%.._,� �K'IS4-- )am, CF iz, /qGrti.aVe,. LAUGJ) /h--. If: g - Zs-•-3+z / A L.w/ Ll x lvrrLS 1~� 1 k.r.00 A S-. . o uY� jU-c ccl ASSOCIATED BUILD G PERMIT#(if applicable): MECHANICAL>;PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn _Alteration _Repair Type of Project: New _Addn _Alteration _Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures NC—Air Handling Units Heat Pump 7� Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Z_ Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove " Kitchen Sink&Disposal Grease Trap Gas Range Ducting ) Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas j Range Hood Water Heater Other: . Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER""SUPPRESSION SYSTEM Chemical or Water I Iwo.of Heads 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 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 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, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. • i /..--- City of Everett Official Use Only --A tl PERMIT# '*-1 "--CC—ICS- 0 g0(4, ---CO2--- Owner/Au orized Agent Signature Date (Revise 9/23/2016)