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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 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 /> PROJECT SITE ADDRESS: 5CO SC O Vea'e}} Nice I k `,Joy 4rA i PROPERTY TAX#: :.2S 0`j 1 &00 30 c t J.C. <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: a+ iS C' C,F, � qiL TENANT NAME(If Commercial): -5c)Lct kha►1 C".4.3. <br /> OWNER MAILING ADDRESS: STREET c - .V e dVAC,1 "Al <br /> CITY V�Y STATE V;A ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREETp/��L�Z l�C f�'1�I —�VC 1�C��, �W 230 <br /> CITY (�1 t 1 1 Cf e{-'K- STATE VV A ZIP <br /> CONTRACTOR PHONE: 42C3, '5-� ,C91(0C% CONTRACTOR EMAIL: t"S1 50 SEC- Vn,S (cyvi <br /> CONTRACTOR LICENSE#(REQUIRED): SI�' ��`Yvf'C L?x. .,3 c+ t�, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): L c_3 1 C <br /> PRIMARY CONTACT: ❑ OWNER ACONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: Fno n< CONTACT PHONE: 4 2-5. 33C). 91 <br /> CONTACT EMAIL: I C 0;i CU)'►'1,S o• Corn <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ' ,t CL lContract Price of Work: $ 02. '3`llir' <br /> Proposed Use of Building: t,�11A I Heat Source: []Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: XCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> in5fic�11 (i) I_GI� Wckt� Sicy, A\S0C,-1 <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 List of Fixtures #of List of Fixtures #of 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 Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration IShower 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 /> Number of Heads L I I <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.l 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 /> s PERMIT# <br /> O ner/Authorized A ent Si nature Date (Revised 5/20/2016) <br /> I� <br />