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• PERMIT APPLICATION • <br /> BUILDING / MECHANICAL I 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 161 ' Wal(u.f S Lo I PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: /i 1C�{/ � p�`eto_fA i TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET .j 6 3 a. (-f (f`koo n\"L Cw c-.e— n <br /> /' cm( �� V\v\l..L)iD� C STATE IL)(T ZIP 8 0 3 7 <br /> y <br /> OWNER PHONE: ,9- 5J 9 7 7 5 5 87 OWNER EMAIL: , KourdcL(4 (D 3 U <br /> CONTRACTOR NAME: <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: IKOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> 4i�I�t KOU-V Jath CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of W rk:$ i/ <br /> Proposed Use of Building: Heat Source: ❑Ga ['Electric er <br /> Building Type: ❑SFR-Detached ❑SFR-Attached 0 Duplex ❑Multi-Family-#of Units: 0 Commercial ❑Industrial <br /> Type of P)ect: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: gerect <br /> f -a c/ ` <br /> Roo 3 rel s 5 14 <br /> - s , �� <br /> ()A ce ott, 1 .eAAA, tJt_ s2 t C S ifLt',LS e s A.4.AA n s/0-0 AI U.LL.J t3VL O <br /> (ifapplicable): f�i'awe__ L-,0-U{ M&t - �'r /9V/wk./JAI- (fe e- /n�,sLGtn-61-h . <br /> ASSOCIATED BUILDING PERMIT# a licable : (I <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 /> 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 /> 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 1 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 /> PERM <br /> af- 1 3 --3o -( 7 c s -- os <br /> Owner/Author zed Agent S nature , Date (Revised 9/23/2016) <br /> -Ilia(tit you. ; allrlpc-e <br />