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PERMIT APPLICATION <br /> 01111111PBUILDING/ MECHANICAL/ PLUMBING I 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: /9O7 g,9/‘,E44 nye Everdereff t vF* PROPERTY TAX#:4,c//7000r 2701__ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CIN STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> • <br /> CONTRACTOR NAME: P/NN/'I Ct,f ,l3 v/GDgee.- !/(.G <br /> CONTRACTOR ADDRESS: STREET &/ s- ' E/„5(meq D,¢. <br /> CITY L1 (MvAJ STATE (.J& ZIP €71323 fe <br /> CONTRACTOR PHONE:tar- 27S_&3-7o (o CONTRACTOR EMAIL:f/yf^„,/4,htiA Qwe,,Zgm�;/, foes'»® <br /> CONTRACTOR LICENSE#(REQUIRED):7 //I/NJ9ez. $gziosty'CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): l�Oi-t..(/f!( <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) I* j?1(-j <br /> �2S -Z"7S —(eSlo <br /> CONTACT NAME: CONTACT PHONE: �744-7� l <br /> % <br /> m 1 7Zd-)E!L J4ilnialL CONTACT EMAIL: dinnae leec; cnorri <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ C/4 Oer <br /> Proposed Use of Building: • Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New Addition DRemodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: R t,/Y!u v1✓ -X)I7/ j C/97 x-7 -/44.,,g0/42> /Arra 57C I <br /> Wt 7} / plc." D�G�c-• 4!i) SOfl/ q/g Ztcs50 <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/SUPPRESSION SYSTEM <br /> Chemical or Water 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 be ng 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 .e 1Y:to Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> / PERMIT# <br /> WI?"-- <br /> IV �/ X35 .Q1.) <br /> �. <br /> •w 'Authorized Agent Signature Date (Revised 9/23/2016) <br />