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• i <br /> 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 33 I I e 0 L PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: IC 4(-K TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET I) L J Lf- - II'i I "' k S'/z Y"/ 7-k <br /> / <br /> CITY i�/+ /�- J STATE v,4 ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME, Lti 1 L j, C CI cru 7X yc-T/A-V, <br /> CONTRACTOR ADDRESS: STREET `�—J 0J E L /�f Sif�•� J p✓ /W 7- <br /> CITY <br /> CITY +""rr�` �` J/ V;-,0-� STATE LL zip <br /> CONTRACTOR PHONE: �}� 5 — 2 3�� 3 S CONTRACTOR EMAIL: f,J /L-1 C', CL�,✓7r�.��'�)`L- C /I 'K . C <br /> CONTRACTOR LICENSE#(REQUIRED): (, ) L L CsC CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: ry� 1 CONTACT PHONE: i)OL, - X53 G� I0 <br /> 0�31i 2 1 !� K h I C' l F �� CONTACT EMAIL: r J)r,�> Y r S 2 v' v 411 6)0 c C-eki <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 19-P i I Contract Price of Work:$ 7000 — <br /> Proposed Use of Building: -5"A—M F Heat Source: ❑Gas PElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex N-Multi-Family-#of Units:_ ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel TZRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: F2 S 2 1: 4 e r ;Z C/}-,),i i t 1--)Z vJekL y��� c /e S: e N Til f W :2 5 <br /> s•..i i7 r c 1: 6 L-a/r G- , w c '!1 eft P S <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 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 Oficial before being authorized under any circumstance.I am the owner,or l am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ,�� PERMITt/>`��/lam <br /> C:9..r/Authorized Agent Signature Date (Revised 5/20/2016) 1� <br />