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� PERMIT'APPLICA710� <br /> BUILDING / MECHANICAL/ PLUMBIfVG / SIGN / SPRINKLER/ DEMOL1710N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or Blacic In1c Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �CZ `I� � S�' S� �✓P-/Zr�fF' i�A �1'�'�� PROPERTY TAX#: - D �3 fJC�" C lL�n <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> � N'�a"�'� � J TENANT NAME(If Commercial): <br /> OWNERNAME: l.� 7cxn F��,� ,17� �S ul;�e2v.'> -, <br /> OWNER MAILING ADDRESS: sTREEr J�'7' C7 /11 ti ��1 -r} S �C GI`wtL S��}-e Zt�I (tJ�U <br /> CITY �f�(k i I��-(��Q STATE W/Y S�'!�-r K �I.,✓1 ZIP ���.�-/ 1 <br /> OWNER PHONE: �Z S -'j 5 L - (� OWNER EMAIL: ca ✓n u v v�- rnGca l. [-vY+'� <br /> CONTRACTOR NAME: �c..�vt e,r <br /> CONTRACTOR ADDRESS: sTReeT <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: ^ <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: LdJ OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: t 2� ,..��� ���� <br /> AhG�`�t�I� �JI��t'�✓S�i CONTACTEMAIL: c�,y„��;i��VG' � ✓�z2.1I. �-+JVVI <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: R�5 i�.t.�, `c;� Contract Price of Work: 1 <br /> ProposedUseofBuilding: (�S;��c�S;�.�� HeatSource: ❑Gas L�Electric ❑Other ,- <br /> Building Type: fi71SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: --�__�1C�rrrerciel� ❑Industrial <br /> Type of Project: ❑New ❑Addition l�Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ./ - <br /> R2YYlpLLc�l�ttJ � Rt2.'w�ur'ikq U�� ��.C-k � 3J:.. � �C'�i�u� ID x IU nPw ��t=CIC <br /> J <br /> :;GhVer�iK� ��. 5�t�n2r.� i�na-o ��ctrc��jQ � C�1nvQ,r-'}-irm� L.aannc�/'y �ucvn •�v Y�ec�rvv.�n <br /> J <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 _Aiteration _Repair <br /> #of Lisf of Fi�cfures #of List of Fiztures #of List of Fi�ctures #°f Lisf 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 ea e Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> �PSt1Nb(LE�3/ SUPPI3E�Sl��1 �XS'i'E!!/l <br /> Chemical or Water 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.Devrations 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 /> � E, � � Crty of Everett Official Use Only <br /> L/�n�cch � +(�ri se�i � P IT# <br /> ..�• /�'xe�M�};ve �I�us�"tz� �( l�i /7 —��� <br /> Owner/Authorized gent Signature Date (Revised 9/23/2016) <br /> 4�� <br />