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• PERMIT APPLICATIOI• <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 4e77 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: /{O/ Tf7/ � �� SG1/T� /�B PROPERTY TAX#: :9 C, /7,90 40 40a <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: fIAN A /2&�- LLG TENANT NAME(If Commercial): IDAW `T 79it-,lk I <br /> OWNER MAILING ADDRESS: STREET //V/ /?7'y #tT Sj5 ,Su/rC /9..3 <br /> CITY G W CC! 7 STATE I�A ZIP q e <br /> OWNER PHONE: 4-- 35-7 D 2/ 1OWNER EMAIL: on W te4-t ya k- /Vet a L• 4., �- <br /> CONTRACTOR NAME: "(1 B . <br /> CONTRACTOR ADDRESS: STREET <br /> CIN STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR 6KOTHER(Please Specify) N i 1 TEL <br /> CONTACT NAME: UII- A-RGN/76if is LLG_ CONTACT PHONE: <br /> /�WANF.Tf/X�i(r 6AEk CONTACTEMAIL: d(�bGf�/c (� e{% fltYG�r'7�t't"S, Cwt►-+ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 8 Res-f0411re-wt- Contract Price of Work:$ Ul DOC). <br /> Proposed Use of Building: 6- RPStac�/fit w�- CNV Chc(n e) Heat Source: b6as ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: dKommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition Remodel ❑Re air ❑T.I. ❑Sin ❑S rinkler ❑Demolition ❑Chan a of Use <br /> DESCRIPTION OF WORK: <br /> 2AiufrG e�STNftp ' 4cJ1XIMkIloz g4 <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 P Toilet B flow Preventer(Inside Bldg) <br /> Forced Air S st U ' eater Bathtub rinal <br /> Gas Piping oiler 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 Hookupd 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 I I 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 /> 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 /> City of Everett Official Use Only <br /> /� <br /> f /-T yo/' PER � -�nq -- 6 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) (� <br />