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OrETT ' PERMIT APPLICATION S <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.gov/permits <br /> PROJECT SITE INFORMATION Pk" <br /> PROJECT SITE ADDRESS: I , 1 I - z ( l k,J , t t�,(,PRplbERTY TAX# : 9‘G‘1 i: � <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal 'lotion) <br /> CONTACT INFORMATION <br /> OWNER NAME: 13)61_,Vt! AA I J t) AAA t TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET\ lQ 'L I \ ft 1 `L)�7•1 Ii',),,,,.Vi fl.� + ' •• (v 1,/'-,e <br /> g` ( } <br /> CITY /_,!;1,_1,k, f, STATE 4./'-,e i\ ZIP q )71 1i / <br /> OWNER PHONE: t c (.-3 -- i OWNER EMAIL: v` * "" <br /> CONTRACTOR NAME: IZ t .,_, i£'.b,V <br /> CONTRACTOR ADDRESS: STREET 1 I L ' 2 1 `I" S & / - <br /> CITY A,t STATE 4/V A 1 ZIP C/(?)L) I J <br /> ',CONTRACTOR PHONE: H*2-'5.-1 i '-`t l 7, e( CONTRACTOR EMAIL: VV ( t' <br /> CONTRACTOR LICENSE#(REQUIRED):f)-T 11,En fit t.' �c-;I0-C"� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):Of 2 i (- t2i <br /> PRIMARY CONTACT: ❑ OWNER L CONTRACTOR ❑OTHER (Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (...1-21------- 13 C7 <br /> /ijl /tit titk_ fl/t- C)V1 '2 CONTACT EMAIL: (/\, I I/1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ ` , i- 4, - <br /> Proposed Use of Building: Heat Source: las 0 Electric ❑Other <br /> Building Type: DSFR-Detached -R-Attached 0 Duplex 'Multi-Family-#of Units: H. ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition DRemodel DRepair DTI. DSign ❑Sprinkler 0 Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ( f' V I `A-(1Q_ (214 (A/L1 ( r.�� t- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION i <br /> Type of Project: New Addn ,_Alteration _Repair Type of Project: _New _Addn Alteration 135,1)410 <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units Heat Pump Toilet Backflo reventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urip <br /> Gas Piping Boiler Lavatory(Wa Basin) Thinking Fountain <br /> Water Heater Refrigeration Shower Z"Floor Drain _ <br /> Gas Fireplace Wood Stove Kitchen Sink&Dispel 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/B Mop/etc.) Other: <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 with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> .( (_.- _ . ') ( Of 0 q i ri \V\A. I't,[O— DV' <br /> Owner/AuthoriztrdZgenf Signa 're"::. Date (Revised 10/12/2015) <br /> r� <br />