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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 44 rr 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 6(E)gverettepsgeverettwa.gov i www.everettwa.govipermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdiviston t,rzt No, (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Chi, f, Darit, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srREEr QZa Pu. K <br /> CI?YSTATF ZIP QB2-01 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET /� <br /> crry V A STATE ZIP <br /> CONTRACTOR PHONE: Q CONTRACTOR EMAIL: J.e4a i e J C+-Y I-eQa.' ,t - com <br /> CONTRACTOR LICENSE#(REQUIPED): CTr' q�tf1FAyN B-7 Z,d= CITY OF EVERETT BUSINESS LICENSE#(REQt1[REO): (yO <br /> PRIMARY CONTACT: ❑OWNER §6 CONTRACTOR El OTHER(Please Specify)._ <br /> CONTACT NAME: CONTACT PHONE; ;6 A59 0 <br /> 1150 <br /> CONTACT EMAIL: t Q Mkeaj n ,?c M <br /> BUILDINOWRIVI T AP LICApON <br /> Existing Use of Building° I Contract Price of Work: $ <br /> Proposed Use of Building: Heat Source: ❑Gas lectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Famll -#of Units: ornmercial ❑Industrial <br /> Type of Pro act: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑5 rinkier ❑Demolition ❑Chan a of Use <br /> DESCRIPTION OF WORK: <br /> FffIaCe hi2ai �2mf -4- &1 V' h iti' <br /> ASSOCIATED BUILDING PERMIT#(if a IicabLe <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _Naw — Addn Alteration _Repair Type of Project: _New _Addn Alteration _Repair <br /> #of List of Fixtures #of <br /> Fixtures Fixtures List of FJxtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> A/C-Air Handling Units I Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiter 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 /> Chemical or Water I I No, 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 I comply with the Stale Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> �f�17 <br /> PERMIT# <br /> 9 .11%/u (7119 <br /> 14Pdk/Authorized Agen ignature Date (Reviser!9/23/2016) <br /> � v <br />