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411 <br /> II <br /> PERMIT APPLICATION <br /> 111111 BUILDING / MECHANICAL/ PLUMBING/SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> vitt .Of 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:Ele 3 Z 0 OSteAT C f ft n PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision `Lot No.i (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 5.1421)e 5D rar S TENANT NAME(II Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> ^ SU f <br /> CITY T f '/eZt STATEfir* ZIP 9g263 <br /> OWNER PHONE:& ...23,-/J-/`v0/0 OWNER EMAIL: <br /> CONTRACTOR NAMEcyn n 1n C. <br /> 14 CONTRACTOR ADDRESS: STREET ' brocj,, <br /> CITY 'C.rT,+{,tt. STATE -i,A- GIP qg z 0.1 <br /> CONTRACTOR PHONE: 425 `,'j9. 0550 CONTRACTOR EMAIL{U t., c Vt�n •corn <br /> CONTRACTOR LICENSE#{REQUIRED):� '"- R 1q.. CITY OF EVERETT'BUSINESS LICENSE#(REQUIRED); NNo 9 g <br /> PRIMARY CONTACT: 0 OWNER I CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: f^C^ CONTACT PHONE:��I��2S 255 t-}, 4 J� <br /> ei)J CONTACT EMAIL:C_�.�C.1l a C tt 'QTS. .co ro <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 2 <br /> Proposed Use of Budding: _Heat Source: ❑Gas Aectric ❑Other <br /> Building Ty-pe:AR-Detached CI SFR-Attached ODuplex ❑Multi-Farnily4 of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: aII "Q` Tfumf 4 f —r { _ <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 _Alteration _Repair <br /> it of #of <br /> Fixtures -- /atuf ri4turv _ • o T IWres 7ilii <br /> s� F res Fixtures <br /> List of Fixtures <br /> NC—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 /> a Exhaust Fan Sink(Service/Bar/Mo./etc. Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Chemical or Water I No.of Heads <br /> ACKNOWLEDGEMENT.t 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.t 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 Stale Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only I <br /> 1.) 11.27.17 PE ` A - , <br /> Ow er/Authorized Age Signature Date (Revised 9/23/2016)9 <br />