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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN I 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: g �! v B rceLJ&-y, -V �;C . PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: A; TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREEr y0 " IJYpcic�wc <br /> CITY STATE w ZIP <br /> OWNER PHONE: tl Lj- j c 9 OWNER EMAIL: <br /> CONTRACTOR NAME: Z4 OL 4 eld GG <br /> CONTRACTOR ADDRESS: sTREEr Po Bo <br /> CITY -r Q"/ STATEZIP <br /> 5 �(p 7 <br /> CONTRACTOR PHONE: 23— Q —C`I 1f c1 CONTRACTOR <br /> NTRACTOR EMAIL: Iv�-kC'6 �-czl l C'�c (r TOC" <br /> tQ <br /> CONTRACTOR LICENSE#(REQUIRED): N 4J C, 1 k CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER {$CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: I_ ) CONTACT PHONE: - -/05--- !7 <br /> (/lG�✓{C , CONTACT EMAIL: ��, Act b� L��hC'�e:�� Q . C.C"�1• <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ,n Contract Price of Work:$ 70 l <br /> 17,c• <br /> Proposed Use of Building: 5 4A rl- Heat Source: ❑Gas ❑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.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 13c,4h rtacwt ve ll+a uk r►�ova s BW4 c z w r/�, &Mo ve t <br /> � kol-c <br /> QU/ &A �,r�U✓t> v ��� �� � 6 rvr/c ; ,pia al,e , (Jrl m of iir�u.� 36 "�, c12-" <br /> �}ea6 r,,�; I-e-c ricJ WerL f -AtrhrVvi zcJ-r c . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): qw 1h, 6 oto <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 I 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 oder 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 Contr aw 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMITY i ^ ' <br /> er/Authorized Agen ature Date (Revised 5/20/2016) !)J <br />