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4reEn- PERMIT APPLICATIOI <br /> BUILDIN■ ! MECHANICAL / PLUMBING / SIGN . J! 'RINKLER / 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION 00000.3'0C <br /> PROJECT SITE ADDRESS: ..�3; 7 /�t-/t A.l/C l� PROPERTY TAX#: 010 5061 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: PC 1V\ pis.`-,l L—v;k_ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET c''7 ' ( )5f 4 e.. (--(-) J <br /> CITY V V 7/ /C STATE :'t A. ZIP e/�,D,y co-.61- <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: L-. k..�' ✓`/ `TG7-etn 0j 1Y,1 I 01---N <br /> CONTRACTOR ADDRESS: STREET Cy 3 0 Z s \�L C� t,--1©t" Fi�tG C., <br /> CITY L'"l/CC. /J' J STATE lit-iir ZIP 4-rJ <br /> CONTRACTOR PHONE: ZC16 • 7 I G;'' zO(Cr(Di , CONTRACTOR EMAIL: )C t -C dO( � 1 I ✓-L� =_J?�C� <br /> CONTRACTOR LICENSE#(REQUIRED): LA C V <le 1 I 1 IL CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):'%5l_' <br /> -' <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR OTHER(Please Specify) 14-.� 4f.ny� <br /> C9NIy1CT NAME CONTACT PHONE: U/Z4.0 v 0 3, 0 <br /> L`\Lq lrri(1)4>lig"\ CONTACT EMAIL: 12,9c. - i (,,, 1(/ 6l--tri 51-1 `C-'&-L--- <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ems ✓'' <br /> ( L&. r-'vt. - Contract Price of Work: $ / 7I OC -0 r <br /> Proposed Use of Building: ji vl(' I( f'" '..– 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 ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: )1 X / t (Zoo( S�) <br /> 4j4QCC el S �-/ C <br /> 2, p eL L. <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 #of <br /> List of Fixtures #of List of Fixtures #of List of Fixtures 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 /> 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 /> 11.4. PERMIT <br /> (;)D9-- Opt <br /> Owne/Authorized Agent Signature Date (Revised 5/20/2016) <br />