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PERMIT APPLICATION <br /> ,,,y, ,� BUILDING / MECHANICAL/ PLUMBING /SIGN 1 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3,2,r) � ( ( c S1Yee� l , <br /> ve,„( .tt c( <br /> PROPERTY TAX#: 0032 L(c2�( Soo <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: aft 7Q 1jN TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 7 -9/ ,046c5'pa .-Itic <br /> CITY STATE A / ZIP 7,,.! j r <br /> OWNER PHONE: / _q r)/ �,, O /?-67Y OWNER EMAIL: t t2.,,„g / j „,,c, . [.,„ <br /> CONTRACTOR NAME: Cr41.14e12. <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):N\•J <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR Iii4 OTHER(Please Specify) ap/ ),5(.A.14/1\f-- <br /> CONTACT <br /> 3(.A. /1\f- <br /> CONTACT NAME: CONTACT PHONE: 4Sj� e <br /> Q)°`"4-. ,� N jule <br /> CONTACT EMAIL: t <br /> dLIA)P _ min ..Ct11Y1 <br /> BUILDING PERMIT APPLICATION 1 <br /> Existing Use of Building: Contract Price of York:$ Ale <br /> Proposed Use of Building: Heat Source: 0G. IN - - =• er <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial CI Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Ae u04 d'e Uf^atA i”i 2 t S'�Y'iil.f.+tm , , Aid)1Yl'IY1. S` t' Llil'°.. 41.61-`" <br /> s- ba,c.6 <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 #°f 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 /> � <br /> ' City of Everett Official Use Only <br /> PER ```.J`^� k ` ". 00 <br /> . /�VO C <br /> All ner/Authorized Agent Signature Date (Revised 9/23/2016) <br />