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el" PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/PLUMBING/SIGN I SPRINKLER/DEMOLITION <br /> viii CITY OF EVERETT PERMIT SERVICES <br /> ' 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.govlpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: `L Lt 5,-.54-1.A. ' PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: "131/'"y r-1 P1 y i TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET c�,r.�.�1 ,J�/LI/ �� Ft e. ,� y,�y `/�^ $Or <br /> CITY C ...it • e...yr d_. .._.. STATE (,ryro`�". _ ZIP f '="„.••(*,..9 <br /> OWNER PHONE: , .,--1-. () , 4 SS' OWNER EMAIL: <br /> CONTRACTOR NAME: [ f�I -te - Crre,'`' <br /> CONTRACTOR ADDRESS: STREET / l "1-..: pbte. ), <br /> e <br /> CIN L .„ _I j Y . STATEWA_ ZIP61'5 c?'''''' <br /> 6° <br /> CONTRACTOR PHONE: 411---a-,q -- 33$ (1-1414,4e1 CONTRACTOR,� 0/91/4,6,7- 7114 EMAIL: d a ,it,�r" s,J,y� <br /> CONTRACTOR LICENSE#(REQUIRED): 1( -31j)o '7 i.. tri) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0(L.)74 <br /> PRIMARY CONTACT: 0 OWNER ,CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 1,1%4.45 ... 33 }} ,,.- ° ` i <br /> " t--Y- " �� i. <br /> CONTACT EMAIL: `3t Y'. `" %7'7,-.t#-- 44 t"(L° 11,-)'"ae.,/ -. <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:S <:>-.'' C, > <br /> Proposed Use of Building: Heat Source: las ['Electric ®Other <br /> Building Type: FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New DAddition ❑Remodel VIRepair DIA ❑Sign ❑Sprinkler ❑Demolition DChange of Use <br /> DESCRIPTION OF WORK: ( � e <br /> Li . �p <br /> _ N- vr..„ '� LitttAtAnc),cc 1.. .t.k. l Lt'mac..-°ti..c.A- <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 /> NC—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 I 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 /> City of Everett Official Use Only <br /> iti:/ <br /> a PERMIT ( /. <br /> elf 67:0) 6) -.1,5—1—7 <br /> 24 L.4 <br /> Owner/Authorized Agent Sigatture Date (Revised 9/23/2016) <br />