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0 PERMIT APPLICATION. <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> ,01A--P. <br /> CITY OF EVERETT PERMIT SERVICES <br /> Nifitiwy <br /> ' 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: J 6")? L(/tk,( //(J(' p_ue ' .(-t PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ' e (CONTACT INFORMATION <br /> OWNER NAME: wA l�Kc� 6cd, h/�o i (-- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: 9.-‘7 -RD7/ OWNER EMAIL: hal d Q 6 y41,0,_ <br /> 41,c_ (owl <br /> CONTRACTOR NAME: [Oil P.i n�j (,CJ CQi,?('�/�IO.�T, j: 3 (�`�j e c A-\ S`,Jc_� <br /> CONTRACTOR ADDRESS:2Gf Q 1 STREET '...I 1 i(d 5.f <br /> UU <br /> / l Y 111 <br /> CITY e (Z64/ STATE Lt/( ZIP ?g 20 1 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: A35 C)C)/1 S (.245/14s ' ', now - + <br /> CONTRACTOR LICENSE#(REQUIRED): 14,6 1 ) e( / {(l CITY OF EVERETT BUSINESS LICENSE#(REr IRED: ,�R 0 ,� <br /> PRIMARY CONTACT: 990 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) - 174C <br /> CONTACT NAME: (J)j( liLlti 9I( k C L CONTACT PHONE: 266-3-. (2 .,5 e <br /> CONTACT EMAIL: <br /> u15gc'��gR <br /> � .‘y�(' �giit4G11 PGOVIA <br /> BUILDING PERMIT APPLICATION ,,----"'`-- <br /> y <br /> Existing Use of Building: Contract Price of Wor..$ \ '0 2.-- <br /> Proposed Use of Building: Heat Source: ❑Ga• ❑Electric •• •- <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ECommercial ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: kc - Roo 4k- 0_,Aout,g 45,1___ ..._0)c,1/4_. <br /> /� <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 /> Chemical or Water 1 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 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> � <br /> ' A/ /l P VAIT:�n cr,p —00 2_ <br /> •• er/Auth:rized Agent Si='attire Iv ' Date (Revised 9/23/2016) <br />