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6.,,Jom <br /> /YIP' I PERMIT APPLICATIO. <br /> BUILDING / MECHANICAL I PLUMBING / SIGN / SPRINKLER I DEMOLITION <br /> `04 ".1.4"7- CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERE I I,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 (E)everetteps@everettwa.gov www.everettwa,govipermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3(1. Cz PROPERTY TAX#: Z9() ) 2ft,C <br /> LEGAL for new construction: Short Platsubdritsion Lot No, (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: p c.(-8 TENANT NAME(If Commercial): r-) j T: 5"Aii ) <br /> OWNER MAILING ADDRESS: STREET 3 6,c, s <br /> ctrl ciL,u)e, t-sr STATE A- ) 2c; <br /> OWNER PHONE: 54., 3 - OWNER EMAIL: <br /> CONTRACTOR NAME <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REOUIREci: CITY OF EVERETT BUSINESS LICENSE#(REOUIRED); <br /> PRIMARY CONTACT: i;k6WNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 5-t3-33,-, <br /> CONTACT EMAIL: t-ec <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $‘,114,,f't <br /> Proposed Use of BuildingHeat Source: El Gas DEloctric ElOther <br /> Building Type: DSFR-Detached CISFR-Attached 0 Duplex 0Multi-Family-#of Units: OCommercial 0Industrial <br /> Type of Project: ONew DAcidition 0 Remodel ORepair DTI, 0Sign EISprinkler EKmolition 0Change of Use <br /> DESCRIPTION OF WORK: • I `-`) <br /> SIX r1161 <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 #of #of of <br /> List of Fixtures List of Fixtures List of Fixtures # 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 /> INumber of Heads <br /> ACKNOWLEDGEMENT have ievlewed this application and confirm the information contained herein is true and correct Work done pursuant to this permt must comply with <br /> current federal state,and local taw. 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 Me owner,or I am autnorized by The owner of this properly 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 /> ( CO 0 7 —000 <br /> Owner/Authorized Agent Signature Date (Revised 5120/2016) <br />