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PERMIT APPLICATION <br /> ,/�/ BUILDING/MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> r 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: //‘,37. (�r7 3Di/ I PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision CJ Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:5Qj4 i 14-L, <br /> TENANT NAME(If Commercial):J�C'` <br /> � QVV <br /> 4(._...e._....., <br /> OWNER MAILING ADDRESS: STREET \ <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: /4 akittLe de7k2S#'UC7't&Pl <br /> CONTRACTOR ADDRESS: STREET 215 c/?€ k 54 <br /> CITY Mea ,/(._ STATE ZIP ?8 <br /> CONTRACTOR PHONES 0 '-"Y749-l7%' CONTRACTOR EMAIL;,r,h��HiLe n tame,',tat, <br /> _cet4.._ <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIR-D): <br /> PRIMARY CONTACT: 0 OWNER (CONTRACTOR 0 OTHER(Please Specify) _ <br /> CO CT NA CONTACT PHONE: 0_ *2 —/7?4" <br /> 1 01/1 (Um CONTACT EMAIL: - fGtttt ' -/40 /ht4'. . <br /> BUILDING PERMIT APPLICA ON <br /> Existing Use of Building: TE4A/`f Contract Price of Wor :$ t <br /> Proposed Use of Building: OM S )2> a., Heat Source:. %3as Electric ■• <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: .lkommercial 61 strial <br /> Type of Project: ❑New DAddition iiiRemodel ❑Re it DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of se <br /> DESCRIPTION OF WORK: - <br /> X 1 767—00/ 2 - God l�r�/14-y, t740,- --5 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New 11(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 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 /> Buildin. c oral before•-ing authorized un.- - - ce.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> an. comply with the s ate Con ac• Law 18.27 RCW and 2•.. OOA WAC. <br /> City of Everett Official Use Only <br /> !. I ' � 1 �� PTU <br /> o� 6 <br /> ►w • •uthorized Agent Si -ue Date (Revised 9/23/2016 <br /> 9 9n ) <br />