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PERMIT APPLICATIO� <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 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ,3� (;� �'('��� AV G PROPERTY TAX#: �� �j j I � Q Q SC7 J O D C7 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No.� (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ,(,�(�` ����� (-}G�ICS TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReeT 2 Z '� '�.1` ���(, �� <br /> ��n r . ;��.� STATE Z�P Z7C� <br /> OWNER PHONE: Z�- �L- Z OWNER EMAIL: �v� hc�ac�b�i.��P1rS C M <br /> CONTRACTOR NAME: "k �`"v-���;S {-}c:v�EyS <br /> CONTRACTOR ADDRESS: srReer � g'l� �Ut� � '-- <br /> CITY ��` STATE �AJ� ZIP ��, � ��/ <br /> CONTRACTOR PHONE: ��'Z���[-�'Z`C 2� CONTRACTOR EMAIL: R C L-' ��alaQ C �i C,�- E'1�S�C i�� <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L12�_ 2�'e •- Z � Z 9' <br /> � QL,,�, ��C�,C.�� CONTACT EMAIL: � `�,� �, <br /> l�L l�tl 0.�..c !�rz-� P►r.S. c c '� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: � �-Q Contract Price of Work:$ ����� � <br /> Proposed Use of Buiiding: " Heat Source: ❑Gas �Electric ❑Other <br /> Building T pe SFR-Detached ❑SFR-Attached ❑Duplex �Multi-Famil -#of Units: ❑Commercial ❑Industrial <br /> T pe of Project: ❑New ❑Addition �Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: �,�� ��,`'���o�1� � �`(�f,C.�'1�-in � C���� �l�c fr�:C�t�� I1� S c,{�c=(,�--i C� � <br /> �����.1� <br /> ASSOCIATED BUILDING PERMIT# if ap licable): <br /> MEGHANICAL 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 Fixiures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixiures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg) <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 No.of Heads <br /> ACKNOWLEDGEMENT:I have revrewed this applicatron 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 wrrting from the <br /> Building Officia!before being authorized under any circumstance.!am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> ��- 1� -1, :-�,��-�� �; ?='_� <br /> Owner/ t rized Agent ' tur Date (Revrsed 9/23/2016) <br /> „ ! <br /> /Z <br />