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PERMIT APPLICATIOP' <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 1 FAX 425-257-8857 1(E)everetteps©everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Slack ink.OMy Please,) , .,_ . . PROJECT SITE iNFO.RMATION .? ,,.,.> :;/,..:';". . . . ,.,.F , z. ,_,,.. <br /> PROJECT SITE ADDRESS: r 14 Z7 10Q 64 �� I)AJ[1---30PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ��,44 a4 L/.ti6Qu1 scr ST": <br /> NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET / / Z7 /D 014 / - JJ) VN <br /> �t�frCITY 6' r ?2 STATE ZIP <br /> OWNER PHONE: ('77 a) Z©5 6,`7g !OWNER EMAIL: ca -vt 3 S-'Q 4,1,-( �, (t ,.,,,(iP <br /> CONTRACTOR NAME: t6,e6-L� pyZ <br /> ` . /J C. C�_ <br /> CONTRACTOR ADDRESS: STREET ! 70 se 1 02_0 i:-.4._ <br /> /c�� -S'LZI /j{, <br /> CnY l.Jd/f 4- r Z��+Y/�/ C STATE /f1'_'_ ZIP 3 <br /> CONTRACTOR PHONE: (4206, 1 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): t/Uril�C��C �®z CITY OF EVERETT BUSINESS LICENSE#(REQUIR ): <br /> PRIMARY CONTACT: 0 OWNER ECONTRACTOR 0 OTHERPlease Specify) <br /> pecify) <br /> CONTAC AME:{,, j �f,/' CONTACT PHONE: 7 k / ` S <br /> r VA E�1fTL_� CONTACT EMAIL: /1371p eA/e / J,tIs/tit d,- C-‘,/t1 <br /> ILDINGPERMIT.APPLICATION , <br /> Existing Use of Building: y j,Q Ji Contract Price of Work:$ (p <br /> Proposed Use of Building: ,Heat Source: ❑Gas gtlectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project:XNew ❑Addition ❑Remodel ❑Repair ❑T.I. CI Sign OSprinkler ❑Demolition CI Change of Use <br /> DESCRIPTION OF WORK: 0 Q4— k Akere& <br /> - <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 /> NC—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 I 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 con. with th State C.ntractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> P IT <br /> I <br /> -12 -0 Lk2.- <br /> Owner/Auth•rl ed Agent Signature Date (Revised 9/23/2016) <br />