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• <br /> PERMIT APPLICATION <br /> #1111P/10111Y"::‘ BUILDING/ MECHANICAL/ PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> ,4,4 CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov I www:everettwa.govipermits <br /> (Blue or Black ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: G fr I I PROPERTY TAX#:Obi ?; <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Aii'`� f1 f ,/ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1.(f L (I Iitirl li il u" 4,ie- /J/ <br /> CITY e\frp-., STATE ,/V ZIP `1U��U3j <br /> OWNER PHONE: O 9 <br /> .} .S 3 0('igfj OWNER EMAIL: & <br /> k}iltjelclir17(,,CP L J aC <br /> LM ,1 ,((/j.,,. <br /> CONTRACTOR NAME: r , J <br /> CONTRACTOR ADDRESS: STREET ( 7 �3 `i t U-1 <br /> ¢ <br /> CITY l t (4-e 0 STATE Il/t/j ZIP �1 ,,j� .. <br /> CONTRACTOR PHONE: `�1 .j ' Ll 3 v Yj�C 3'5- CONTRACTOR CONTRACTOR EMAIL: lj}-otbe tj.4�-(O1'' J <br /> CONTRACTOR LICENSE#(REQUIRED): 13Et FF5 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 114 j�t5 <br /> PRIMARY CONTACT: 0 OWNER (^CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: )` q 4 3 <br /> / g J 5 3 <br /> l f (-2vi--ir CONTACT EMAIL: I,-.. .fG .�( tre I;Lt;fit <br /> D <br /> BUILDING PERMIT APPLICATIcN <br /> Existing Use of Building: 17- .„ {t Contract Price of Work:$ "f/� <br /> ,600 <br /> Proposed Use of Building: I) Heat Source: ElGas DElectric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel )Repair ❑T.I. OSign DSprinkler ❑Demolition DChange of Use <br /> DESCRIPTION OF WORK: <br /> "i f t A , ..t r,. - vtrwlz r I, I.?, I've- Q4-' <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 <br /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures <br /> NC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> ;j.-- 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 I 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. Tire 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/am authorized by the owner of this property to perform the work for which application/s made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only PERE <br /> IT# <br /> '-'--- ' ''' ( , 1 -7/ (--7 <br /> Owner/Authorized Agent Signature Da(e (Revised 9/23/2016) <br />