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4rETTPERMIT APPLICATIO <br /> BUILDIN / MECHANICAL/ PLUMBING /SIGN / PRINKLER/ 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: c. Z G uz� c;\ �,x <br /> (J lti:+ PROPERTY TAX#: (, L{l[1 (5Cpoo--'ci O <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: tA;- ll i tL_✓iti TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1v"Cil ?..,(7) u' DD•�— �r <br /> CITY v 0 • STATE E.- 1. ZIP q5 2 U�3 <br /> OWNER PHONE: j OWNER EMAIL: <br /> CONTRACTOR NAME: Iv Dt`e.61-Nt-\ L,4,>' lt-r- <br /> CONTRACTOR ADDRESS: STREET (`-(r.)Z S( 5 1-P f S v7.--2 <br /> cm( C_ A..rt'-1- STATE ( C1_ ZIP ?U p3 <br /> O-CONCONTRACTOR PHONE: 70c, 3-2)- CONTRACTOR EMAIL: .)uJ DNhL\ ] )A.„-( vkc L54 . KO-- <br /> CONTRACTOR <br /> TRACTOR LICENSE#(REQUIRED):Qt--lk-) ._Q_4j q CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):05(254O <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 70L - pC-r <br /> 0-\:c__-\c,,2,\c0-\:c__-\c,,2,\ \'�,` V , \ c*te-\I CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ D,D(9O <br /> Proposed Use of Building: (70__l— Heat Source: ❑Gas NElectric ❑Other <br /> Building Type: ❑SFR-Detached R-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Ey. eca-pj Zo K <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 #°f List of Fixtures #°f 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 1 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 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 ontractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 11/14144 C �- R PERM, l1D1 'c 1 �yOW�er/Authorige At Signature Date (Revised 9/23/2016) <br /> /z <br />