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0 PERMIT APPLICATION16 <br /> BUILDING / MECHANICAL/ PLUMBING !SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 58203 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)evereteps@everet-,v4a.gov I vnvw.everettwa.gov;permits <br /> (Blue or Black ink Only Pleasel PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:007- L-'('-- LA/ 4FD TAX#: <br /> LEGAL fo'new construction: Short Platisubd,vision Lot No. (attach copy of tong legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ) / crA P.✓n TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET QQ -' ' ' �/ -3 6* <br /> OWNER PHONE: — — �G+ I CS OWNER EMAIL: <br /> CONTRACTOR NAME, 1'G4--k) � f l y <br /> CONTRACTOR ADDRESS; STREET <br /> cl-1 STATE CAIA ,ZP t 0� <br /> CONTRACTOR PHONE: CON�}TRACTOR EMAIL: J/• <br /> CONTRACTOR LICENSE#(REQUIRED): c4/� Q Q R CITY OF EVERETT BUSINESS LICENSE#(REQUIRE <br /> PRIMARY CONTACT: O OWNER CONTRACTOR ©OTHER(Please Specify)_ <br /> CONTACT NAME:,'t/vk Vl ��+► ��ujsC.y�L% *, CONTACT PHONE: 25 — --- <br /> CONTACT EMAIL: % Ll�f W--%, --co <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ a-0 <br /> Proposed Use of Building: Heat Source: KGas ClElectric ❑Other _ <br /> Building Type: ❑SFR-Detached ©SFR-Attached ClDuplex Multi-tFamil -#cf Units: (p ❑Commercial ❑Industrial <br /> Type of Project ONew ❑Addition DRemodal ❑Repair OT.I. OSi n ❑Sprinkler ©Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> e v"r,vl,. E4:3 <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 Bld ) <br /> Forced A'r Systems Unit Heater Bathtub Urinal <br /> Gas Piping Bailer Lavatory Wash Basin) Drinking Fountain <br /> 4later Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ductinq Dishwasher Roof Drains <br /> Clothes Drier Hookups Other: \\7 Clothes Washer Medical Gas <br /> Range HoodWater Heater Other: <br /> Exhaust Fan n: Sink(Service/Bar/Mop/etc-) Other: <br /> SPRINKLER 1 SUPPRESSION SYSTEM <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT,1 nave reviewed this applicalion grid confirm the information contained herein is true and correct.Work done pursuart to this permit must ca+npi,'with <br /> current federai,state,and fecal law. The granting ora pe=rmit only aufhotfzes approved•r✓crk and no deviations therefrom.Deviations must first be authorizer in writtng from the <br /> 6uildirg Official before being authonzad under any crrcums[aree_i am the owner,or t am avvt orrzed by the ov;rer of this pruper;y to perform the work for which app',canor is made. <br /> and 18.27,RCN and 29F.200A WAC. <br /> City of Everstr Ltftrciat Use Only <br /> d/Z/f � PERM \9(7E� -DCS <br /> Owner/Authorized Agent Signature Date (Revised 912312016) <br />