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PERMIT 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 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> r s <br /> PROJECT IT INNORM.*1"IONCn fS T _.. $F <br /> PROJECT SITE ADDRESS: 6\ (1, [sA t PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:cu Y l �(j iC{l�7-1 (4/\. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ci 1 <br /> CITY CApeA/ l/ STATE JA- ZIP el <br /> OWNER PHONE: Lf � OWNER EMAIL: <br /> CONTRACTOR NAME: G LAA.( RLA 1 <br /> CONTRACTOR ADDRESS: STREET <br /> -e �i�p '1 cf',� / � ( /vin <br /> C—IT�Y /�V --�1-7�V-+L C4L ��,� Y �-�-+C_ IAJA- <br /> S/TAATEE .,,/ ZIP .�,G1, S <br /> CONTRACTOR PHONE: _' I t '� l 3 if CONTRACTOR EMAIL: V\1 tL L (u 2. 'dvLi? t• <br /> con <br /> CONTRACTOR LICENSE#(REQUIRED): FF CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER XCONTFIACTOR 0 OTHER(Please Specify) <br /> CONTACT NA E: - CONTACT PHONE: 14/27-c--";--t--1 <br /> r '—a ,° <br /> (! <br /> t( LOi `a- NIA(30- CONTACT EMAIL: VL` Q.. c&c £ tib <br /> BUILDING PERMIT APPLICATION°. . <br /> Existing Use of Building: Contract Price of Work:$ ..5 I (-- <br /> Proposed Use of Building: Heat Source: ❑Gas Electric ❑Other <br /> Building Type,R-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition El Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> (A✓1/\CG .-e v iH -f J ,D I - - <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn ,Iteration_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— it Handl' - 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 /> 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 1 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 /> r ( City of Everett Official Use Only b 0'7-'4 1 1 Le PERMIT oNi <br /> Owner/Arized Agent Signatur= Date (Revise 10/12/2015) <br />