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PERMIT APPLICATION <br /> BUILDINWECHANICAL/ PLUMBING /SIGN /AINKLER/ 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 7-7105 PROPERTY TAX#: OOy 3c114 7 L1dU <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 21.I��J Ven4y ve LL6ANT NAME(If Commercial): W CA 1 V1 S <br /> OWNER MAILING ADDRESS: STREET X E>MbQr ('V CAr. S c ZS ZO <br /> CITY %n 'F n ,SCO STATE A ZIP Gy <br /> OWNER PHONE: OWNER\`EMAIL: <br /> CONTRACTOR NAME: I �e C,� St tq Cf i6 vv <br /> CONTRACTOR ADDRESS: STREETS AZ CA, S . <br /> CITY 1�'\},. v>!mQVA STATE \AJK zip a$Z7 <br /> CONTRACTOR PHONE: 1CONTRACTOR EMAIL: j It M !r Cresl n.covin <br /> CONTRACTOR LICENSE#(REQUIRED): MC4ERSAO3SQE CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): OZ$O8q <br /> PRIMARY CONTACT: ❑OWNER .CONTRACTOR ❑OTHER(Please Specify) ,1 <br /> CO TACT NAME: CONTACT PHONE: 3(06) LIN- I SZ5 <br /> 'bw\c sc"a5 s CONTACT EMAIL: `� e COSI n •CD✓� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 1,500 <br /> Proposed Use of Building: Heat Source: []Gas El 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. XSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 1&(e i e4�Gl CQ W1 e✓1� 6 Ify�CriUmC yl� S I <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 JRoof 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.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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> (5wndr1Xuthoriz6d Agent Signature D to (Revised 5/20/2016) \ <br />