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PERMIT APPLICATIOi <br /> elli <br /> BUiLDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERE I 1,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 ,-lack ink Only Please) PROJECT SiTE INFORMATION <br /> PROJECT SITE ADDRESS: 2.2/7 7 !i 4 t4 e/ Ave.. UvePett. PROPERTY TAX#: G G ty7b9 7 p'9Ga`IG <br /> LEGAL for new construction: Short Plat/subdivision Eve,#-j Pig.4-pIOlot No/ 9(attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ?2/7 f .tit e.✓ aae. LLQ TENANT NAME(If Commercial): J1/4 <br /> OWNER MAILING ADDRESS: STREET 1 fr f Y( of f-A N. Lt/erf <br /> CITY Lx 4 1y oo 41 STATE 14,4. ZIP 9/ 77 <br /> OWNER PHONE: 2.D G 1-P7 710 I LOWNER EMAIL: Cf�I'fa." .all 9',f dr ,ik-h a 1 .Go h. <br /> / <br /> CONTRACTOR NAME: cD1 ha 9.4.e_ G oA J b-4 c-t o y L(..- C. #fr <br /> n ^, 2 i <br /> CONTRACTOR ADDRESS: STREET l',") 7 f j Gir`t,j Jc ill? aG fr 0 7 7 4 LO 3 r�j2/ 1 1 <br /> CRY 179/b 1,17„ STATE 14,14• ZIP 9J <br /> CONTRACTOR PHONE: 15-- PI,– O?SIJ CONTRACTOR��� EMAIL: h P 4:$1/0"2- .4L 4 & -- '.6,sh, <br /> CONTRACTOR LiCENSE#(REQUIRED): L �'4 t /I r( 12.07 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED <br /> PRIMARY CONTACT: 0 OWNER 0-CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:: 1 CONTACT PHONE: L'LS 4 7 a—0_Pro' <br /> LZ if <br /> ...ea,...ea,A-1/4 CONTACT EMAIL: A'6 Ga t91.'G,ry <br /> .Gd..„ <br /> BUILDING PERMIT APPLICATION er- <br /> Existing Use of Building: _fp_ 1? Contract Price of Work: G G e <br /> Proposed Use of Building: C.a li,0(Uf Heat Source: I$lGas ❑Electric ■aCher <br /> :Building Type: ®SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Units: 0 •mmercial ❑Industrial <br /> Type of Project: ❑New ❑Addition El Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler 7-4 se i.'ion ❑Change of Use <br /> DESCRIPTION OF WORK: v.eAh` ems;(Yi l,5 stil 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 Re it <br /> #of #of #of #of <br /> List of Fixtures List of Fixtures List of Fixtures Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC–Air Handling Units Heat Pump Toilet Bac Preventer(Inside Bldg) <br /> Forced Air Systems Unit He- Bathtub • al <br /> Gas Piping Bo' Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater -efrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Dispo - Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups; Other: Clothes Wa.•-r Medical Gas <br /> Range Hood Water -- er Other: <br /> Exhaust Fan Sin ervice/Bar/Mop/etc.) Other. <br /> SPRINK • I SUPPRESSION SYSTEM <br /> Chemical or Water 1 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.1 am the owner,ort am authorized by the owner of this property to perform the work for which application is made, <br /> and t comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> .7).**4177)7N—....-------- 1,--.°Z7'1/4 77 PE' , • 9-1 - <br /> Owner/Authorized Agent Signature Date . (Revise.9/23/2016) <br />