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PERMIT APPLICATION <br /> /' BUILDING /MECHANICAL I PLUMBING I SIGN /SPRINKLER I DEMOLITION <br /> ` CITY OF EVERETT PERMIT SERVICES <br /> a. ;.;.;'? 3200 CEDAR STREET,EVERETT,WA 982©1 <br /> (P)425-257-881U I FAX 425-257-8857 i(E)everetteps©everettwa.gov I wwrw.everettt,va.govipermits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:3. G L''SE i.- Vu PROPERTY TAX#: , <br /> LEGAL for new construction: Short Pint/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1.4e)-11-•;I rOkA�'-rCs" TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ESA-C I Tt 40 _ <br /> CITY Vr' 2- * t STATE L'�.7 A z1P t <:7 c..^ )..'.. <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> e 1—• <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CiTY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ,.rt OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: cam'-- .-.r 5''` <br /> 1-11.-F i ' CONTACT EMAIL: .<,-„m . po I . c':1 0 I"C",,L'it, •C.C.A.A. <br /> ;BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 'PV... v'v.a '—y t L= t --(.z = Contract Price of Work:$ <br /> Proposed Use of Building: 1 Heat Source: Gas 0 Electric ❑Other <br /> Building Type: FR-Detached DSFR-Attached ODuplex DMUIti-Family-itof Units: DCommercial 0 Industrial <br /> Type of Project: ONew DAddition ❑Remodel j21‘pair OT.I. ❑Sign DSprinkier DDemolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT/t(if applicable: <br /> MECHANICAL PERMIT APPLICATI•N 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 Fire•lace 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 i Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Number of Heads 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.I am the owner,ori 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 111.27 RCW and 296.200A WAC. <br /> _ --^"- City of Everett Official Use Only <br /> /" t PERMIT if ' , O2/ Q'-, <br /> Owner/Authorized Ago - :+. tire Date (Revised 10/2/2015) <br />