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PERMIT APPLICATIO <br /> BUILDING / MECHANICAL/ PLUMBING /SIGNPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:3217 W bG_K er--EC-L;EY. A-U& PROPERTY TAX#:fib 15/ m 745194 QbO <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (.t L (��yvL(( j ("/L TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET �j Z,/7 We (6 L,L j( v6i-t/ <br /> CITY E u L'_ILC_ 17 STATE (Aj ZIP Ci g z o <br /> OWNER PHONE: 4/2,5 -eiOWNER EMAIL: <br /> CONTRACTOR NAME: /+Okt4E(J c Cold.STa(,(C.T °Ai <br /> CONTRACTOR ADDRESS: STREET l?d 80 K L (g ? <br /> CITY AA.p JL,( E STATE l.JI1401A(&7-.J00_1,<5 <br /> �/ ZIP 27 2 <br /> CONTRACTOR PHONE: 42$ -74/-"Z(,8'7 CONTRACTOR EMAIL: SC�c‘(•L 1401A( Jp2K5eA-t1 (_e.,CS)Nv\ <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):� ed( <br /> PRIMARY CONTACT: 0 OWNER KCONTRACTOR 0 OTHER(Please Specify) I t <br /> CONTACT NAME: CONTACT PHONE: .4-7_4.1--__9.0// 2h,87 <br /> o bL-1 UE(L CONTACT EMAIL: .-6 (ems Tom- bluff€A(-- . csC <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Z CAR_ GA-2A CVContract Price of Work:$ 3q O'UO <br /> Proposed Use of Building: z CA Z C-A-g_a.c E. Heat Source: ❑Gas ❑Electric ❑Other /&[oit.(L <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: El Commercial El industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> C--0M3 2v c t i-iEt Cn/c2.A-C1 E <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 #°f List of Fixtures #°f 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 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 /> PERMIT# til o /1 Odk <br /> 7/Z1-/ <br /> OwnerlAuthoriz gent Signature Date (Revised 9/23/2016) <br />