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• 0 <br /> ,4P PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/ PLUMBING / SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERE i I,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 l(E)everetteps@everettwa.gov 1 w w.everettwa.govipermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: S13tp 504"Q PA ye., PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal descripton) <br /> CONTACT INFORMATION <br /> OWNER NAME: FevrdIAC4 f d. 50u-,47,16t C,t0 TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET 5'7 3 :, S0U,ru cl 4v_. <br /> cRY r-V .rt.4 STATE \tJ 4 zip CI fit;W 3 <br /> OWNER PHONE: 1.2-5 - 111 - 3LiLIL} OWNER EMAIL: / C�1-e_C S .ppC�?raj <br /> CONTRACTOR NAME: 1 S± Qe.spx sc 14PA if A-Ir' 5 I GC�t alnc L 'f C. <br /> CONTRACTOR ADDRESS: STREET ! 4 i31 3 (o `r'� tot \l S LA,4-.G T. <br /> CITY Li Yln Duboct STATE w ZIP alg 340 <br /> CONTRACTOR PHONE: 24)6, -(pi-f3- 15x5 CONTRACTOR EMAIL: i r i neted.A re o v e_.kv c .car) <br /> CONTRACTOR LICENSE#(REQUIRED): . .$T IE R) 50 P3 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0 5 5 ZI$ <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: C CONTACT PHONE: ell J --�-7 !Gl- 3 t,.j -1 -1 I cow)Flit 'G3)rand &tJ iC4c f CONTACT EMAIL: (�.'..C.�..ct6 •pp 3 i ,tow) <br /> BUILDING PERMIT APPLICATION j' <br /> Existing Use of Building: =Contract Price of Work: $ �5 ID, JO <br /> Proposed Use of Building: Heat Source: 'Gas DElectric DOther <br /> Building Type: DSFR-Detached j4FR-AttachedODupiex OMuiti-Family-#of Units: DComMercial Dlndustrial <br /> Type of Project: DNew DAddition ©Remodel DRepair OT.I. OSign DSprinkier DDemolition ,Change of Use <br /> DESCRIPTION OF WORK: <br /> e-,-;r0 41.- sclik/rna C.4. <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 /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water ' No.of Heads <br /> , <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 porfoml 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 /> -, f PERMIT#j <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />