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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ DEMOLITION <br /> /="1 <br /> ` CITY OF EVERETT PERMIT SERVICES <br /> lai3200 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) PROJECTfSITE/ INFORMATIONL _ <br /> PROJECT SITE ADDRESS: (�/0( j45:co c f od tai J/ ri ,S/ '/17 ( PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> •, CONTACT INFORMATION 1 <br /> OWNER NAME: Ut N, fe1.t,(�('5ID ( TLJ&(iNANT NAME(If Commercial): [(e cam%'✓t c_- 7724-.1.-Pi,-v <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: �( <br /> !C, <br /> CONTRACTOR NAME: c_/-�, i 216 i �+�0 lei �.C4AA-A� \ ,(C-I21— <br /> CONTRACTOR ADDRESS: STREET /i I /^/55,7/5.e-G-I az f---e_4- g c 5 t A6 ( <br /> CITY " V V e____. (�', STATE LAIki_ ZIP ? ° f' 63 <br /> CONTRACTOR PHONE: a ,�\— CONTRACTOR EMAIL: ,Q CC,- C..- E�! eJ,', 7n i V1-4 k' ' C..64,C..64,CONTRACTOR LICENSE#(REQUIRED): IV CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> kiek— <br /> PRIMARY CONTACT: 0 OWNER ®C NTRACTOR 0 OTHER(Please Specify) / <br /> CONTACT/ NAME: 7�`�J.:5-c_4-e—(` CONTACT PHONE: X6.3 -, -v-0 - -735( C e-1 <br /> �/l/ J�lij�j as �" � CONTACT EMAIL: c(CJG e-/ _ -1-,ca,yji'Nl.'p✓`—Lo"^<_— <br /> �//�� BUILDING PERMIT APPLICATION® 4 <br /> Existing Use of Building: �JTV Contract Price of ork:$ C3COO <br /> Proposed Use of Building: Heat Source: Gas DElectric ❑ot r <br /> Building Type: DSFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-# Units: mmercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel DRepair rYi EISign ❑Sprinkier uuemolition ❑Change of Use 71 <br /> DESCRIPTION OF WORK: /-e � A-Pe) <br /> d t� <br /> /" ` /"5 G'v LLJ�C_ d >s- If y e 1-k- 5'-- 7) f leo y�� t-f' <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 /> 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 I 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 Contractors Law 18.27 RCW and 296.200A WAC. <br /> t City of Everett Official Use Only <br /> / <br /> Y"kl_---z__-2..eA,------7..,__2.74_/ 2 <br /> oco ...... oss <br /> Owner/Auth. Ized Agent Signature Date (Revised 9/23/2016) <br /> I <br />