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4-17- PERMIT APPLICATIOD <br /> BUILDIN i / MECHANICAL/ 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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: a-'1 ii STU - St' C'V'Q'ut-t- 7i PROPERTY TAX#:E70Sei3Sbc16C Q-10 L <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: '- k,03.0 1\S c--1 2s+-* ) C TENANT NAME(If Commercial): -c_ye_a0t t -k- ' J€ - <br /> OWNER MAILING ADDRESS: STREET J( <br /> CITY (:..AXY l�T'I STATE \I ZIP g -al.'I <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: f`r 14-003 \r'Q <br /> CONTRACTOR ADDRESS: STREET �j l7� ti^ Cil - 5. <br /> CITY Sear CL2 STATE 1 ZIP ' ?XO/ <br /> CONTRACTOR PHONE: (at)t ) 0`14 0 CONTRACTOR EMAIL:.P _,L,16 ktrt-t c)c] <br /> CONTRACTOR LICENSE#(REQUIRED): 1-ti-DU0")e 'L.LkL CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Z:3 <br /> PRIMARY CONTACT: 0 OWNER j.�CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:'')( I l!( CONTACT PHONE: Z^v19 �l O` 14C <br /> CONTACT EMAIL: . re\- j tZ _Lr,-- <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: t/JQe ,hi;;Wit' /, 1CeS,A;l, _ Contract Price of Work: $ ;yi.;? 7 DC <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: ti New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: > > S-r�rY1 tyro YY�IX 1'1�-} <br /> fnSTa i tcrt"1 0- a `�nVoc+\z�n � c1Qv� c�ne.r�(cq� ; . �5:,�-\ \z2`;5\0 ��� C J <br /> -1C= )Gt1Y ink <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project:_,;c. 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 /> Number 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 /> City of Everett Official Use Only <br /> PERMIT ' t')0(9- C)C <br /> Owner/Authorized Agent Signature Date (Revised 5/20/2016) <br />