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PERMIT APPLICATIO4 <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> *1747T 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) PROCT SITE INFORMATION <br /> A.)PROJECT SITE ADDRESS: 62. , CASM A.) 6 F. W 98)( PROPERTY TAX#: ix'"i 2I 1 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy long legal description) <br /> CONTACT 6I NFORMATION <br /> LIIT" <br /> OWNER NAME: C*( -i 6f i P "LD.4611: ' (,,ZUe't TENANT NAME(If Commerce : <br /> OWNER MAILING ADDRESS: STREET g.r/2/ I(?, �, x-16'-- (Oa-- <br /> t,) ,(--Wtt CINY` STATE ' ZIP 93/44 <br /> OWNER PHONE( cai <br /> lam')' 5 OWNER� EMAIL:� `'�1� r' ,3 t. :3 i, At._,, <br /> CONTRACTOR NAME;" KO*/(� 0435"( c i � <br /> s 3 (� •W UL <br /> CONTRACTOR ADDRESS: STREET 2223 tit- Alk kE (02-- <br /> 4. <br /> CITY � UE STATE �, "` ZIP 11%�X <br /> - <br /> CONTRACTOR PHONE:(t (-6e 11, CONTRACTOR EMAIL: lity'1/"'" COUtitilet �' <br /> CONTRACTOR LICENSE#(REQUIRED): S =�e35kj CITY OF EVERETT BUSINESS LICENSE#(REQUI D): <br /> PRIMARY CONTACT: 0 OWNER 6 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT <br /> �N�A�ME• j CONTACT PHONE: 026)4,'9t..ej -� <br /> J� � � -'�TYI" - ,` CONTACT EMAIL: J'g1J�►`jMMS c6)4((�RS1 •l <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: GA/+1C- Contract Price of Work:$_4569 <br /> Proposed Use of Building: 0394/0/i/Ty £ arettO Heat Source: ❑Gas [ lectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: El New ❑Addition 94Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> I <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBIN PERMIT A 4�LICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: N w _Addn AS'Iteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump 1 Toilet , Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler t Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove I 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 lam authorized by the owner of this properly to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW,,, <br /> and 296.200A WAC. <br /> i City of Everett Official Use Only <br /> Aku\) <br /> ,A � � P # <br /> Owner/A thorizeil Agent Signature Date (Revised 9/23/2016) <br />