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PERMIT APPLICATION <br /> 'BUILDING I '.HANICAL / PLUMBING / SIGN / SI 1'"JKLER / DEMOLITION <br /> 4,#11100,lc CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:81.2,c <br /> gg ThL S PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: / r,: J/ G u �i tv, / TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRES : STREET g,:2S ge /v* `ti <br /> CITY ,b- C., Q It STATE v....,A-- ZIP <br /> Y67.-O <br /> OWNER PHONE: 0 :1.3- 737 3 23 I [OWNER EMAIL: a'E' f I ft-" 1�e0 •.s�ClLCivt 4'At;K Kiwi ce, 1 -O4 <br /> Opel <br /> CONTRACTOR NAME. 5f `/ <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: El OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Al 2-5" 7 3 7-3.2 3 / <br /> ,A,- <br /> re l.-/G It ti 1.‘ i �CONTACT EMAIL: leiq 'o l e/ea �t(n.c (�"CI'1 . a:', <br /> BUILDING PERMIT APPLICATION �•/J J_' ,/ <br /> Existing Use of Building:J)Gi-S O,,i u I Cet..3 r c/ C.-✓t a.. Contract Price of Work: $ .')O'CI <br /> Proposed Use of Building: r <br /> p �(a.^�o.�LG� I?re��A c? A c e Heat Source: ❑Gas laleElectric ❑Other <br /> Building Type: ID/SFR-Detached ❑SFRR-- ttached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: <br /> CI ❑Addition L7 Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK/:: R4, „✓e, p i t, ,, y. 20..„,, .I Lc/ ?q v► c c= ii"o d 1 10.4 ✓tA` v' <br /> sfi© �'y�at-T cart c?/co/•Q, —Ff.J.+1 voiel o-F reAto./acj Zero C4!aea,Ie. <br /> wood b..� .,<r►. el , 1 S J a ✓Q , il e-`y a/Govt a"-aQ v ;It be_ usoJ -to ,`•�-s I/ <br /> 0 1 w -rr cz a .�"l ct✓i d 4 c1 ' : 0 o1 ,a :A e. ti . vl Cf .S I c'► c/G% <br /> ASSOCIATED BUILDING PERMIT#(if applicable): J <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 1 <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 I 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. 1...* <br /> City of Everett Official Use Only <br /> PERMI.,1 <br /> Z.Z.'ll' IL- 3 / �ec /5 <br /> OwnerlAutho, zed Agent Signature Date (Revised 12/2015) ` ;� n �� <br /> . II ,, r , p 'c � 0 `GFh1C, /✓�IO�-' <br />