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PERMIT APPLICATION <br /> ,411f. BUILDING / 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: 792 g - Hvce.. - 1 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision //9 e- D/a1 Lot NoS S/ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:0 04_14.../949)7),)c-.7 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET/ O si_eJ {jz-,r' j YyZepig �1Q ,m0 <br /> Fd�e-t-6) CITY /> k'Aii4�ii STATE 9 9 ZIP <br /> OWNER PHONE: OWNER AIL: <br /> CONTRACTOR NAME: k,./pi.? X4 2 1 <br /> CONTRACTOR ADDRESS: STREET ,P X "� <br /> / e e_ wre ITYSTATE ZIP <br /> CONTRACTOR PHONE: ..../.‘... 57. 2/3'l/4 CONT TOR EMAIL: <br /> ____ <br /> CONTRACTOR LICENSE#(REQUIRED) 116 /#4,l1O7"P/J CITY OF EVERETT BUSINESS LICENSE#(REQUI- a �/, )AD <br /> PRIMARY CONTACT: 0 OWNER I1-CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4(.7 .5--- <br /> ` 3-57Z) z>g + <br /> de/79/ ��A. ,b,/c CONTACT EMAIL �J9 >f/p7/ . r n `/'& <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: j'?/i{) Contract Price of Work:$ L.,.�# <br /> Proposed Use of Building: tr eSjeig,r2 Heat Source: ❑Gas 1 lectric ■ether <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex LhMulti-Family-#of Units: / DC, mercial El Industrial <br /> Type of Project: 5�lew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler 0 m II..'.n ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ,C;0 /, ') j/With hdZAJil <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 0 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 /> City of Everett Official Use Only <br /> PERMIT <br /> A/ i ;- 'Mc4'--' /— .-- tn n 1 1 ()V <br /> wn /Authorized Agent Signature Date (Revised 9/23/2016) <br /> ‘C. 2... <br />