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PERMIT APPLICATIC <br />BUILDINJ I MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES 30 <br />n <br />3200 CEDAR STREET, EVERETT, WA 98201 1 U04elo <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) SITE INFORMATION <br />rr����PROJECT <br />PROJECT BITE ADDRESS: I,--, j (JUt�}�'1 lbrC01 -1-cu-1 "�'v�-' (A�OZ <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />J <br />OWNER NAME: Cqk &Ii- �?2WIIUZI TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET -CUD 6�1� ✓ Sh^r� <br />CITY STATE ZIP '{- !) ' <br />OWNER PHONE: /' <br />OWNER EMAIL: k-'! rk <br />CONTRACTOR NAME: R01r+tAW-L& f►m <br />CONTRACTOR ADDRESS: STREET n S 5�. <br />1 ,' <br />crrY K %t- STATE WIC ZIP Qp p05;►. <br />CONTRACTOR PHONE: -ZOL0111- 15C)- <br />1 CONTRACTOR EMAIL: KbtreCif G� U! i i �e S i si�„Ins . Ga�1/✓\ <br />CONTRACTOR LICENSE #(REQUIRED): a <br />ICITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER E6 CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />I' t a-\ <br />PHONE: <br />LONCT <br />CT EMAIL: �j1iZ OLf f) uoL ti-c 5y Sl try es-LC,w\ <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: <br />Contract Price of Work: $ ` 4 5 4 . 00 <br />Proposed Use of Building: <br />Heat Source: ❑Gas ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi -Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair QT.1. ❑Sign QSprinkler ❑Demolition []Change of Use <br />DESCRIPTION OF WORK: ReulS2 Cp�QX- (.fir <br />�Icis}►+� Sprjlnk.l.w h-�oc�ci;orJs {D P�ravide, - <br />le,-uo tc no-nk I n e,hciz Hv5 bL�'rA' o • W �-KutAL 5.) . <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL <br />PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: <br />New Addn _Alteration _Repair <br />Type of Project: _New _Addn _Alteration _Repair <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />A/C - Air Handling Units <br />Heat Pump <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />Kitchen Sink & Disposal <br />Grease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />Other: <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />Water Heater <br />Other: <br />Exhaust Fan <br />Sink (Service/Bar/Mop/etc.) <br />Other: <br />SPRINKLER <br />/ SUPPRESSION <br />SYSTEM <br />i <br />- Number 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 I de, <br />and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. Z*I- <br />C't f E tt Off' ' 1 IJ � O I <br />s iyo vere ca e ny <br />PERMIT # /< 1(, 0 ! w 0 <br />0 <br />(Revised 512012016) (/�J <br />ed Ag t Sig <br />