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PERMIT 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 I www.everettwa.gov/permits <br /> (Bluff or Black fpk Only'Plesto) PROJECT,SITE`INFORMATION <br /> PROJECT SITE ADDRESS: cfqp A `i PROPERTY TAX#:2(/OS Sn03aS3oc� <br /> LEGAL for new construction: Short Platlsubdivislon Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: }ar1'^Q,rn cle,1C)eve_1 cn Ir l,l..G TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET Rgb'7 7:1t� Ave--,Se, <br /> CITY fA111STATE WA ZIP <br /> OWNER PHONE: 2OG0OWNER EMAIL: <br /> CONTRACTOR NAME! H CA-a r)6- <br /> CONTRACTOR ADDRESS: STREET �, Q <br /> CIN STATE W/ ' ZIP <br /> CONTRACTOR PHONE: C> CONTRACTOR EMAIL: d,i+ g-nV1 }ir`) (off <br /> CONTRACTOR LICENSE#(REQUIRED-):Cft)V1` t.I`406-71d n CITY OF EVERETT BUSINESS LICENSE#(REQUIRED), 1 L1r (a <br /> PRIMARY CONTACT: ❑OWNER � CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: ,,j�/� CONTACT PHONE as a9 �-a <br /> 1 ► tiz d 17' ► CONTACT EMAIL ,fix y 17-h M Vke i" .&D ryi <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ t,,2 000 jg= <br /> Proposed Use of Building: Heat Source: Gas Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Family-#of Units' Commercial ❑Industrial <br /> Type of Project: El New ❑Addition Remodel ❑Repair ❑T.I. ❑Sian ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> Ty)sf 4 AG/wj, cC(5 -6urrtgC.e-1,FvC, �I�t�-k�n ,e15�'1� (�'' �I-ex 6uci- Supp6 Ywefia-k <br /> pgl1 -t-YV Y-- ve-0.1 0A.2-W-t"-A Gltr <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 /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> 1 Forced Air Systems "Unit Heater Bathtub Urinal <br /> Gas Pipin2 Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration— Shower .Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal lGrease Trap <br /> Gas Ranae Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I No.of Heads J I <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 /> p, City of Everett Official Use Only <br /> ,My� <br /> &J- <br /> 'y/'-'ti,, <br /> fI l �- PERMIT <br /> Owner/Authorized Agent Signature Date (Revised 912312016) /✓�' <br />