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grrPERMIT 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 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:72_6 7 vpnc ,2_1.64,6,eaPROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: J YN'1- j / me-S TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET .3,r// 4Ave <br /> CITY "1/�' STATE GA.-A- ZIP g;c o 9 <br /> OWNER PHONE: 44 z S ' 22- /(p OWNER EMAIL: <br /> CONTRACTOR NAME: ,249 PL <br /> CONTRACTOR ADDRESS: STREET.�1 933.6 /,;,2 `Fid <br /> int.-C.- STATE C.(.,/4" ZIP 91'2-2-3 <br /> CONTRACTOR PHONE: 3/ocC- /O 3 -7} L CONTRACTOR EMAIL: ; c)..3'N.-k),\) i.',-ii3C 6-444 <br /> CONTRACTOR LICENSE#(REQUIRED): /?O 3//�f ,271_z 2— CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ?O 8rJ9rY <br /> PRIMARY CONTACT: ❑OWNER COCONTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 14Z S e- 3 V S <br /> y?..e)6/N,S — SLI K S LiG CONTACT EMAIL: IcO&�•JS�✓�i.u Sn.IG/.-c t? G-/uA/,i. 60/2-7 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: N/A Contract Price of Work:$ 3 75 <br /> Proposed Use of Building: S Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: Lti7SFR-Detached ESFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: 1:9<ew DAddition ❑Remodel ❑Repair CIT.!. ❑Sign C§prinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> u L_n- Ai20 osE Ccu�w f 2ci�E.�) t i 2E- SPS.�-�I-C-72 S /z , <br /> / /d' ,L 4- S 4 / R-1,5 <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 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 /> f( 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 /> PERMIT# <br /> S-1/2-0, .c1 (/A0 � ' O U0 <br /> � t <br /> Owner/Aukirized Agent Signature Date (Revised 10/12/2015) `( <br /> Z <br />