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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 /> (Blue or Black Ink Only Please) ``�^, PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: -7Z� W <br /> q W� PAC- 1PROPERTY TAX#: �0392000rx�3goS <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Od/.1 /�/�/t� /'�� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET �n'ew L'bWJ5 -41 rikA �t <br /> CITY �i�'�14-� STATE WA ZIP <br /> OWNER PHONE: yZS quo y— &C-1 S 1OWNER EMAIL: <br /> CONTRACTOR NAME. <br /> CONTRACTOR ADDRESS: STREET -2--2-q '`gyp S7 S•�✓^ nn (� <br /> CITY QO-rye,L(� STATE �ry ZIPZ- <br /> CONTRACTOR PHONE: V -qgl— `�O�o� CONTRACTOR EMAIL: 1ji/A&>A"4C ,7 <br /> CONTRACTOR LICENSE#(REQUIRED): 5k4AJbAESc,&9-3-'9 CITY OF EVERETT BUSINESS LICENSE#(REQUIRE :32-'--5-2- <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: �,,.,,( „N� ����� �/ CONTACT PHONE: � .�.-1/97-491 <br /> CjJ / /C�c s J CONTACT EMAIL: SL4",,tjAAICLp^16AA,, 1 eiPt! -J <br /> BUILDING <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ , <br /> Proposed Use of Building: 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.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: //I�AC.L//t & A IVEti✓ GINS tC;1-01,4GF- (/iV"DlAJ4 61AV 1111A/4 A"b <br /> A-EP1-AG/,J1- f.*-rti/4 ob�,-tQca/�- le,As L�elr <br /> ,ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn XAlteration _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 IShower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups f Other: Clothes Washer Medical Gas <br /> Range Hood (RAf l�—Gc 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:/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/am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply wit the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> P RM # <br /> Owne Author' Agent Signature Date (Revised 9/ 3/2016) <br />