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PERMIT APPLICATION <br /> /1"---"A <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32005 STREET, EVETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257CEDAR 8857 (E)everetteps RE@everettwa.gov www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) `PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: L OI J" 1-8 " e `lV,�f E.V 0 r E.�T PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Dc 1 r h I 1 V P. i e.,19 h . A 0I(attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �UA F'A C N CH 63 TENANT NAME(If Commercial): ,,,rd L <br /> OWNER MAILING ADDRESS: STREET Z C ad CA .,12. f (Ai a 1 ir 10 <br /> CITY \1&F e l STATE N A ZIP 9 e3 Z O 4 <br /> OWNER PHONE: Of e.Ve °i I: F A► 03 e./ OWNER EMAIL:ate J€ , fj1 relit," 0 (-) 5 el.?riiC h c-1,4es. Cc,,..1 <br /> CONTRACTOR NAME: t'(d 'dAteep pJ 'Mbl#J�. 4 toHe'll id1 J u �f <br /> CONTRACTOR ADDRESS: STREET J GJ Z }j IC K?orr� .4YYe., I t.e D <br /> 1 V�`/ <br /> CITY � h o M I S STATE 1,4A ZIP 'I �-) Z 9 O <br /> CONTRACTOR PHONE: 4z -- 2'J r i CC CONTRACTOR EMAIL:ScIieDire �J (�(�if/{New f�lt t�(�jj' <br /> :' ^ ry rv►e�7�I�. i..e--t <br /> CONTRACTOR LICENSE#(REQUIRED): A D J A W P L ( I 1 J CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) <br /> PRIMARY CONTACT: 0 OWNER KONTRACTOR 0 OTHER(Please Specify) ©52gyg <br /> CONTACTfNAME: 0-) { �/ CONTACT PHONE: 4 Z 5 , , 0 _.f_ 5—(�/1- j f j <br /> I?7 Q Ci Y0Vsk ei 1 CONTACT EMAIL:JChLDf,/je ad a,„le e0rji,,M6IN1 ke.eat.) W <br /> BUILDING PERMIT APPLICATION -NI e4 <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: __ ❑Commercial El Industrial <br /> Type of Project:Xlew ❑Addition El Remodel El Repair DTI. ❑Sign prinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> E4 'k1 FaMi1,1 fEe (75?Y114 )Ziel2 <br /> ASSOCIATED BUILDING PERMIT# licable if applicable): <br /> ( PP ) <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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# l 60',. 0? ( <br /> Owner/Authorized Agent Signature Date (Revised 5/20/2016) <br /> 1[) <br />