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IT APPLICATIOP— <br /> (f-illierr BUILDING I MECHANICALS/ PILUMBIING 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: 7 57 a I y I,t pc c V t e w 0 'R PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> - r^ <br /> OWNER NAME: Ad A S Vl a ( <br /> i (.A t!'IA f TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5a v/t e <br /> n CITY STATE ZIP <br /> Jt'' G <br /> OWNER PHONE: -6 �14 0 -4s/g 3s (' �OWNER EMAIL: <br /> CONTRACTOR NAME: �j/�!1 6 f 44n S / _ <br /> CONTRACTOR ADDRESS: STREET 3(2 1 ( 5J &th$7 N W <br /> CITY 5 1-4 0 w 0Q d STATE W A ZIP Crg21 Z <br /> CONTRACTOR PHONE: I 25-2/O c'7Q rj CONTRACTOR EMAIL: -7---0,$.4,6,g/_5 6j 6y welt" d[4✓/ <br /> CONTRACTOR LICENSE#(REQUIRED): 76 t '6fC f o/g 415 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): el," <br /> PRIMARY CONTACT: 0 OWNER Al-CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: /.1-.2_5-2 jQ --sere)5 .----7/ <br /> 7;1744 f 19h 5 CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> v <br /> Existing Use of Building: R Q 5'i Contract Price of Work:$ foOv0/` <br /> Proposed Use of Building: Ries r , Heat Source: , Gas ❑Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: DCommercial El Industrial <br /> Type of Project: ❑New ❑Addition DRemodel DRepair ❑T.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION O WORK: <br /> `0 athreet0 /Lau0drlr0a04 ecw7do1( C <br /> .\,.(i5 . <br /> A SOCIATED BUILDING PERMIT#(if applicable): X (gel 2 66 Z <br /> -MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New X Addn _Alteration _Repair Type of Project: _New X_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 /> 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 /> / X Clothes Dryer Hookups Other: ) Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> ,2___ 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 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ..-. 9' 4 ./..t Aor' --5--C S PER I \.Oa- 002 <br /> Owner/Authorized Agent Si.'a'Ere Date (Revi ed 9 /2016) <br />