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0 PERMIT APPLICATIO <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: I Z 7 W.- Adrri Fa-1 PROPERTY TAX#:06gr?o3oo(,O( OoC) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> A <br /> CONTACT INFORMATION <br /> OWNER NAME: -D a J T= A v\ c e ! TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Zit3( t�od�L) <br /> CITY V.V v.�S STATE (tpl ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 4 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: r, n �^ CONTACT PHONE: <br /> CX ISS 6� CONTACT EMAIL: 7 T (-A t,1 C� f p Cc Cis`(", k1�e t <br /> BUILDING PERMIT APPLICATION —' <br /> Existing Use of Building: I CSC eti.rt I ` Contract Price of W4-:$ Gc =--- <br /> Proposed Use of Building: {crLS I i Heat Source: ❑Ga C��Electric er <br /> Building Type: SFR-Detached ❑SFR-Attached ❑ uplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel , Repair ❑T.L ❑/siign ❑Sprinkler ❑Demolittiio/n r❑Changee of Use <br /> DESCRIPTION OF WORK: <br /> b ne K4,u s i Q,ko- wa((G a X ro rc-�t ove(- <br /> Q C' D r CGti <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 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:1 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, d 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 b re eing authorized under any circumstance.l am the owner,or/am authorized by the owner of this property to perform the work for which application is made, <br /> nd I co /y wi the tate Contractors Law 98.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERM�;- <br /> Oer/Aut orized Agent Signature Oate (Revised 5/20/2016) 1 <br />