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PERMIT 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 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 44507 Pc-b >-,ee.r 4 PROPERTY TAX#:005 1/S..00000360 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 4111/ A.,.e,I !$' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET P/aC7 #0L- 1 irled 101- <br /> CITYe20 STATE WA ZIP <br /> OWNER PHONE: 2e6.- kW-6.S' Z 8 OWNER EMAIL: <br /> CONTRACTOR NAME: yEhaL ZZ( <br /> CONTRACTOR ADDRESS: STREET j 4173'f $.,z, got)417- <br /> CITY, // VQji STATE Lat. ZIP. ,2.G <br /> CONTRACTOR PHONE: V,„20---13-5-7,8' CONTRACTOR EMAIL: Sl C4,41 ,f°pj AO 4.' .GQ os--7 <br /> CONTRACTOR LICENSE#(REQUIRED): (r-4'4 8-70P1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):(3..5- 4 .2, <br /> PRIMARY CONTACT: 0 OWNER FA CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: fla '�_ SI—7, - <br /> re.-b getCONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 75, c <br /> Proposed Use of Building: S ,.�y Heat Source: ❑Gas Electric ❑Other <br /> Building Type: j2SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition CI Remodel El Repair ❑T.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:.-ski D411 0 NVIess ()nip 16/011,4241-74/ 'w <br /> -Z <br /> ,°1L kl'ess, Ob Sas s p;p;py� 4� 1,tl,���c,�A tn.A4Z ci..,-?> �3161. <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 /> ,,,'Z 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.lam the owner,or/am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> -/c2PERMIT#rn I O .- 63 6 <br /> Ow er/Authorized A.>nt Signature Date (Revised 9/23/2016) <br />