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4ren- PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> II I p,�j2 1h everJ PROJECT SITE INFORMATION <br /> , <br /> PROJECT SITE ADDRESSti PROPERTY TAX#: OP ") c0O <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ,/c "Ne!-; , v E—tit TENANT NAME(If Commercial): kiy <br /> OWNER MAILING ADDRESS: STREET pjJQ� Q -17y2< C�9c./,eT , (9 I J <br /> CITY ,Le. z-J //3 -/ STATE ZIP <br /> OWNER PHONE: .. _____.c--7.9 ,__ ---.7__/- – c----//`0!0 OWNER EMAIL: <br /> CONTRACTOR NAME: 2) ,_,Z,Z�7---/5/ 'vr <br /> CONTRACTOR ADDRESS: /STREET A-")el , 6' ' - / J i <br /> CITY Af--"/ 4//e"..1) STATE �G29,aV Z <br /> Q6) ' //3- l ZIP <br /> CONTRACTOR PHONE: _22,-'7 / Tj I2' CONTRACTOR EMAIL: /) ' /4-1e lip/ , 0 --1-frl q <br /> CONTRACTOR LICENSE#(REQUIRED): DS PL tal.qq 164/ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ,,t/" <br /> PRIMARY CONTACT: D OWNER gCONTRACTOR 0 OTHER(Please Specify) U <br /> CONTACT NAME: CONTACT PHONE: •7jpd) 2j1".•—�13 s <br /> yo eiA)q /--; >�-/y CONTACT EMAIL: 2)j� ,�/.-.7�J Z ^?jc/ �1i --71---71- \I <br /> BUILDING PERMIT APPLICATION c� <br /> Existing Use of Building: Contract Price of Work:$ r l C� <br /> Proposed Use of Building: Heat Source: OGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ZCommercial ❑Industrial <br /> Type of Project: ONew ❑AdditionpRemodel El Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Z. <br /> \ c / 21 <br /> -,2 ' � 0z'-'- 7 l-t-Y- ->�•e C 7- i,�-ter . _ - - - <br /> 7 <br /> / - 4.r 74c-/.ova 5 I' <br /> �k <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 /> NC-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 / Shower 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 <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 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 /> l PERMIT# <br /> Ow er/Authorized ent Signature Date t (Revised 10/12/2015) 40gi �c�/,S-12.0 1 --kAltiLA1-1241, (J <br />