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PERMIT APPLICATIO• <br /> BUILDIV/MECHANICAL I 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: (_ (,0 0% PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: CIF m(r - TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNERPHONE: �ZS��Z ��7�� OWNER EMAIL: <br /> CONTRACTORNAME: i[Cl/( cAt PRopgT-t&Stoj'_�r%�� <br /> 4:. <br /> CONTRACTOR ADDRESS: STREET 1"76 2 3 '1'-h 4Ve LI- <br /> c- <br /> CITY Al()AID 5 STATE /j✓ zip ! "�a Z v" <br /> CONTRACTOR PHONE: W 6–Ej0Y-Li(/K CONTRACTOR EMAIL: iv? <br /> CONTRACTOR LICENSE#(REQUIRED): (J S I �k7 U ( �C CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 40P(/C-13 ."`Z) <br /> _ <br /> . ._.._ _. _ - . .. ._ <br /> ._... - <br /> PRIMARY CONTACT: 11 OWNER CONTRACTOR El OTHER Please Specify) <br /> CONTACT NAME: r� CONTACT PHONE: <br /> M Iv L l K/ CP' I CONTACT EMAIL: A l.AIRAt P—V57 ,( #It,PA's'. G�i lt,=i �c��►'i <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: `St„j lE Fh11LX DVVCIJAIZ) Contract Price of Work:$ <br /> Proposed Use of Building: 5 JAi F V-MI 1. DLIV4cL4V Heat Source: []Gas NLElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: it JU--AQW0 (i L-tteCi C6j3(A/CATS I VEW �l�'fPP�� Fu✓, <br /> ; ,�'c✓�h �CA*!�T I J I'VVL P(vv(->iX) I OWL 3 p4Dti5 � zirrF -y °✓t�vflv-,/s 4 c✓,t sAra� Sr zc <br /> ASS CIATED BUILDING PERMIT#(if applicable):QY�1v�✓� CaJCAd1)) ID06 <br /> O*rMECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn _Alteration Repair Type of Project: _New _Addn _Alteration KRepair <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 I 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 /> Number of Heads <br /> ACKNOWLED EMENT.'I have review t is application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current feder ,state,and local law. a anting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building O ial before b 'gauth dze u er 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 c with the a e Co ract w 1 . RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> Z/—/6 PERMIT# <br /> 0%411/Authorized Ag en ignature Date (Revised 5/20/2016) <br />