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044-riPERMIT APPLICATION <br /> BUILDING/ MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue Cr Black Ink Only;Please) PROJECT SITE'INFORMATION, ; <br /> ,-�f o. <br /> PROJECT SITE ADDRESS: ( d r 1J/1�/'`f/Jp Oc. 1=vefe LJtl 1 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: V 0 1Dati kA,3, 1 3(.6y-.ht IyL(1c_ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5-os /O j Pn P1 SC <br /> CITY Eutc -1 STATE (,(f ZIP -/gZ-6? <br /> OWNER PHONE: l{ -- 29 3 - /j y'Z OWNER EMAIL: <br /> CONTRACTOR NAME: C7G4J/tiPl-s- <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ;31,OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: aGas DElectric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: fiklew DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> jU( \A i►'LS Ale,...) + c-0(-•1 S -- <br /> ASSOCIATED <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 I Heat Pump 3 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater a Bathtub Urinal <br /> 5 Gas Piping Boiler 5 Lavatory(Wash Basin) Drinking Fountain <br /> / Water Heater Refrigeration y Shower Floor Drain <br /> / Gas Fireplace . Wood Stove I Kitchen Sink&Disposal Grease Trap <br /> / Gas Range / Ducting I Dishwasher Roof Drains <br /> / Clothes Dryer Hookups Other: I Clothes Washer Medical Gas <br /> / Range Hood Other: _ <br /> Lf Exhaust Fan I 4- Sink(Service/Bar/Mop/etc.)—(—Other:N g <br /> JAW (4-11 Pelrlieht ) <br /> SPRINKLER/SUPPRESSION SYSTEM i <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 <br /> f21 (JbCea-0( <br /> Owner/Authorized Agent Signature Date (Revised 5/20/2016) <br />