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• • <br /> illePPERMIT 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 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.govlperrnits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: WO I *Lr ter L4k1 e, PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: t ayy NQvt:�curl TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREETc ` o' /},r loor 1, s <br /> CITY 6; - `A STATE w04 ZIP ` 326 <br /> OWNER PHONE: 425 a55 (?).3/ OWNER EMAIL: <br /> CONTRACTOR NAME: C/10/ H 11 j16— <br /> CONTRACTOR ADDRESS: STREET I k\6 '&6a( L,(� �r { <br /> _._ <br /> err( t*llik.y eySTATE // ZiP FaC)i <br /> ft <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: t ✓L <br /> 5 �� o�� C��IC'.. c�t�'1- c�:�i CO yvi <br /> CONTRACTOR LICENSE#(REQUIRED): CMvIta nAlik lid r1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED t(„eG ( — <br /> PRIMARY CONTACT: ❑ OWNER 10 CONTRACTOR 0 OTHER(Please Specify) <br /> a5 ,39c , <br /> CONTACT NAME: - CONTACT PHONE: ,.,{,., f <br /> -P b CONTACT EMAIL: ado bl Q ,,,c *i'"�'1 .re M <br /> fff(,, <br /> BUII DINGi PERMIT PIJCATION <br /> Existing Use of Building: �Ciantract Price of Work; q&. 0,0c f <br /> Proposed Use of Building: Heat Source: Gas 1 ❑ElectrIc ❑Other 1 <br /> Building Type: " SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family;#of Unit's: ❑Comrnercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. DSign ❑Sprinkler ❑Demolitton ❑Change of Use <br /> DESCRIPTION OF WORK: 105+„„, f pia c ,l d rf/a c (.9Qs .. rkta,C.L. <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 /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures <br /> i (.0_Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> if 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 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 /> p 1 Q "� City of Everett Official Use Only r <br /> Peti3 4'4�. >+ 7.14'1J PERMI O3 \'Ownetharized Agen ignature ✓ Date (Revised 9/23/2016) <br />