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0lien- • PERMIT 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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2 ( `17) it I \v e_i PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> "'� CONTACT INFORMATION <br /> OWNER NAME: �e•V t->1 C-ine-e..(% TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 21 l3 -1--V(7p_6� 41_64. �i L_' <br /> CITY 2._\I Cat STATE ,��._ ZIP 1 <br /> OWNER PHONE: 2-2. • g/1 - 1�(r; -1 OWNER EMAIL: <br /> CONTRACTOR NAME: { etLc,;(,; 1 -�Z�1 VI ' 1 .��—D`(Yl.�.- ��,(;�yy • `2� , [.LCT L%n <br /> CONTRACTOR ADDRESS: STREET 1 6 (>)H 7' <br /> CITY (,cuvLLL( STATE L ZIP n V-1\-0 <br /> CONTRACTOR PHONE: 3 -LP • CONTRACTOR EMAIL: 111(UX._,) ? ki2GZv .( <br /> (Ty <br /> CONTRACTOR LICENSE#(REQUIRED): nqPA6 14 I (-e.-_,& L -C CITY OF EVERETT BUSINESS '\ <br /> LICENSE#(REQUIRED): ( 536,_. E <br /> PRIMARY CONTACT: 0 OWNER qCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ,(;, •. �J�� - 9C <br /> dfut._ ,6p - CONTACT EMAIL: 1 1,A-6 c �l,Z _Yl Y �-c-i tai ,C i~ <br /> 1_ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ 1C 'C-' <br /> Proposed Use of Building: Heat Source: MGas• ❑Electric ❑Other <br /> Building Type: pSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel gRepair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: �, <br /> { (li-�� - U 0(vg.ee Wz--e t_r\_dk f c1 i <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 /> I 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 /> ( _ <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number 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 wit T•-State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use1Only� <br /> C) ' 1 <br /> ( I I Si (L0 PERMITM I I / U <br /> / \� <br /> Owner/A t •rued Agent Signature Date (Revised 9/23/2016 <br />