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OLTPERMIT APPLICATIC <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 I www.everettwa.gov/permits <br /> ,(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: f ` 2 2,? ) 9 rH IAV(% SCS PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: L aT L Q ur4(.11(, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ??_3 (q sez <br /> cITY fac r-r STATE v._(A ZIP <br /> OWNER PHONE: ( Z 5-- 2_2.,5- (DCa i/Z OWNER EMAIL: <br /> CONTRACTOR NAM E::2--/z/.1-'72,4 SorJ,eCe" L L <br /> CONTRACTOR ADDRESS: STREET /(//0 3 ,S72:."&„/41L-T-24) n p <br /> cITY � on n.6Lr/� STATE �l J¢ ZIP 3 9U <br /> CONTRACTOR PHONE: gar-- 5/(p'(/32 CONTRACTOR EMAIL: COOK(;y! .1-ce)c,wix-C" /'o3e.CO7-9 <br /> CONTRACTOR LICENSE#(REQUIRED):,4 A/fr,e 87 I C.-e9-- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): d.S/98 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 67 Z S' _ f i'C - C-A-3F6P <br /> (1 l ikL X (J(f g CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ /, 606,0 ) <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: USER-Detached USER-Attached ODuplex ❑Multi-Family-#of Units: ....0�ommercial ❑Industrial <br /> Type of Project: ❑New ) Addition DRemodel DRepair DT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> LOC_Ari T f-‘c: AS 0-112-1-c—L.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 /> 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/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMMIIT�#/0"/C / /.-/ Y C 1 r1 0 I- <br /> wner/Auth> tied 'ge t Signa ire Date (Revised 5/20/2016) <br />