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PERMIT APPLICATIA <br /> BUILDING I MECHANICAL I PLUMBING I SIGN I SPRINKLER I 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 /> (glue or Black Ink O.nly.Please) PRoiECT SITE IMFORMATION <br /> PROJECT SITE ADDRESS: 2(� �f ���tt� PROPERTY TAX#: C5©ZO 2,3;0Z, <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> / CONTACT INFORMATION <br /> OWNER NAME: i L �L j f 11l/ J LZ_C_ TENANT NAME(If Commercial): L" 12&,) ` p•tj( <br /> OWNER MAILING ADDRESS: STREET qI /4. efAc GK ✓ 7 no <br /> cLCITY / p��N1Q- STATE ZIP 75206 <br /> OWNER PHONE: �(�- 7U� �(pOQ� OWNER EMAIL: TjA), ShciA <br /> CONTRACTOR NAME: C v(�GV-USAJ S7-a7C "510CICT04trA-r- <br /> CONTRACTOR ADDRESS: STREET 2�1, 1-C) AC-l A o 0- <br /> .J, <br /> CITY �:+ STATE WA- ZIP Q SOO 1 <br /> CONTRACTOR PHONE: zS-25 2��jl J CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): �GUt`T�<rSS 02 20 " CITY OF EVERETT BUSINESS LICENSE#(REQUIRE 0 b s <br /> PRIMARY CONTACT: ❑OWNER aCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �9_ <br /> A✓4t � - CONTACT EMAIL: MA-piLG� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ALLAwvp I Contract Price of Work:$ 101131 <br /> Proposed Use of Building: M#*WV1--AJ.0 lHeat Source: ®.Gas ❑Electric []Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family##of Units: SCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair IK,T.I. ❑Sign ❑Sprinkler ❑Demolition []Change of Use <br /> DESCRIPTION OF WORK: <br /> P-1~PL I A CdtJ Lu Cr t4EAT':e5`*4-1T1P0 LO"I', ovT 17E- <br /> PoPuI 0 5-0t 645 Pipe- 40if b44+" e-00CrA&-. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBIf4G PERMIT APPLICATION <br /> Type of Project: _New— Addn _AlterationRepair 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 I 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 /> _ SiPRINKLPR/S;UPPREssi6N SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:IF 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.t 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 98.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Ekv=r/Authorized AEgeA Signature Date (Revised 5/20/2096) <br /> l� <br />