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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 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 /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:I .ZQ ` +, + 5W PROPERTY TAX#: 0o5Sa500005.200 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 0\a<� 1-s Ney ox-A 0 J5 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET a0 $ "1' <br /> CITY E(,rljn 5 STATE IWO, ZIP 99'0.26 <br /> OWNER PHONE: 11Z6-/775—t'O ?11 OWNER EMAIL: <br /> CONTRACTORNAME NOr iL SU✓� S lAG// <br /> CONTRACTOR ADDRESS: STREET 9619 AU-C, /f/,/ <br /> CITY 5t&41'e-z STATE Wo" ZIP <br /> CONTRACTOR PHONE: a0lo- So?a- 95 70 CONTRACTOR EMAIL: P(o'w-I /10r �SurictS.Gom <br /> CONTRACTOR LICENSE#(REQUIRED): AlORD1.51-1800A ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: O OWNER &'CONTRACTOR O OTHER(Please Specify) <br /> CONTACT NAME: D&-tk RVA---t,e- CONTACT PHONE: �O&-55z- 95V <br /> CONTACT EMAIL: <Aaty c C,S C.boV.( <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: .Sln k ra-v." Contract Price of Work:$ )$ I(o 5. 0 <br /> Proposed Use of Building: Heat Source: O Gas O'Electric O Other <br /> Building Type: QSFR-Detached O SFR-Attached O Duplex O Multi-Family-#of Units: O Commercial O Industrial <br /> Type of Project: O New O Addition O Remodel eRepair O T.I. O Sign O Sprinkler O Demolition O Change of Use <br /> DESCRIPTION OF WORK: �ft4- ,�,-M, ! � `��5 ' ��� -�•�rtL b�o� -�r�SSGS , ZC IJu�(r.Q- �LG�- � • <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 /> #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.1 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 /> CCity of Everett Official Use Only <br /> PERMIT# <br /> --- - y f 1 t�( (a 03 - D <br /> Owner/Authorized Agent Signature D to (Revised 10/12/2015) <br /> I <br />