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f y ' <br /> 4rETTPERMIT 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 j FAX 425-257-8857 1(E)everetteps@everettwa.gov j www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: Yi7©2- 7TH A-Y� SZ Ai d l 1-0-c/BkZ PROPERTY TAX#: 2 �j 1 7 O Z I WO <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ,1/�ZLj'( SCi'(c2oL' 71(-›7Yr i c:j TENANT NAME(If Commercial): ,e41✓f�l& J --A=t7 ` <br /> OWNER MAILING ADDRESS: STREET'-`-. 10 ,"JrlcA1714,1ArY <br /> e <br /> CITY , e �n STATE &VA- ZIP G 'Lr, I <br /> OWNER PHONE:(I{-ZOZjl�i`7'' G/-/' 5 OWNER EMAIL: J -C'LLj I'J9 0 1- P , 4111-1 <br /> CONTRACTOR NAME: .--1. G . P <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: 0 OWNER 0 CONTRACTOR 'OTHER(Please Specify) A-I -1re'i-e--'j <br /> CONTACT NAME: CONTACT PHONE: 2,,c �p'l 3 lqi <br /> `moi &--- Le" /Xit7l O `I`>11Z ++2hr CONTACT EMAIL: S (,(cTc CTLs17l t /-1 S ; c F'( <br /> BUILDING PERMIT APPLICATION <br /> oc� Contract Price of Work:$ j /06.)'-)• <br /> Existing Use of Building: � -}Qt i_)/A-012SL ji �-� <br /> Proposed Use of Building: 2iJ7/')'i1_ ( S[-I4c L- Heat Source: ❑Gas ,Slectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: %New ❑Addition ❑Remodel DRepair ❑T.I. ❑Sign OSprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> Arri li Lk) 14-4 u 4:-1: S V�' (4)/ w �) D1' ►2rN��s Tip+ Z <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 #of #ofList of Fixtures #of List of Fixtures <br /> Fixtures List of Fixtures Fixtures List of 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 /> City of Everett Official Use Only <br /> PERMIT <br /> 2 d //7611u -,.,-D0� <br /> Owner/Authorized Agent Signature /Date (Revised 9/23/2016) <br />