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0 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 /> Q <br /> Blue or Black Ink Only Please) PROJECT SITE INFORMATION � -7 <br /> PROJECT SITE ADDRESS: 3310 e6CKC'FELL&'� �� PROPERTY TAX#: QL f 36c 7 Q <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 4-ttya--Ct/m- L ,5F9VVY?1 e4--C,0.-,J TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET3 0 C rJ5 (�/V <br /> CC CITY u STATE 14 Z VS(e zip U <br /> OWNER PHONE,2/ —o�) t Ct q OWNER EMAIL: <br /> CONTRACTOR_NAME: 1\J I-T-f— lltlmez N 14-ec�77K) <br /> CONTRACTOR ADDRESS: STREET l(p t � <br /> CITY /j A)A WVG,6 STATE ZIP q v✓ <br /> CONTRACTOR PHONE: z4z',;--7 Z57 67 �p CONTRACTOR EMAIL: �j j{x/� j�j�( -�.✓�-(-9T-- <br /> CONTRACTOR <br /> 9T--CONTRACTOR LICENSE#(REQUIRED): Lf CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Q I R,7L <br /> PRIMARY CONTACT: ❑ OWNER ONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �ZCJ�'17�i�Lf� <br /> iZYAIJ � CONTACT EMAIL: S Av'V pts) -e -"Je�- <br /> BUILDING PERMIT APPLICATION <br /> xisting Use of Building: Contract Price of Work: $ <br /> roposed Use of Building: Heat Source: Was ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: � cE i�C—,A577)IJ6- (!!�r`A-6 '"P-A)kC677 GUCPt A),e'r'0 &45 f::'U-R-t/Af-6 <br /> -a �5 r?e- LocsgnoAJ" NC) AJPic) '1 5 PIA <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn g 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 /> Chemical or Water No. 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 /> Wrrent 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 /> rilding 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 /> City of Everett Official Use Only <br /> PERMIT# <br /> 5 /5 too - c ::1 <br /> Ow thor d Agent Signature Date (Revised 9/23/2016) <br />