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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> #.11j-A 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: 4)2-8 f iA / .i h/e.,)FVel-e411 w 9&24).3 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 3%1-(r.4U(/d �anv TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Z�S ut-ah .rQ..- Sbuth <br /> / • <br /> CITY Je STATE 1A)0 ZIP g813+ <br /> OWNER PHONE: i A)6.) )fJ - I575 OWNER EMAIL: <br /> CONTRACTOR NAME: W jtat 1 (-617<e:1::1 b n <br /> CONTRACTOR ADDRESS: STREET 1'i-to (E qc-t-1') j <br /> CITY mond STATE \y)A ZIP 9g-aSZ <br /> CONTRACTOR PHONE: (4;c)(r7}') of 00 CONTRACTOR EMAIL: ,calliarr ha • j.,))arr'.eaI Gc <br /> CONTRACTOR LICENSE#(REQUIRED): WW1- r.1„3 &.f CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): !,CGS 3 <br /> PRIMARY CONTACT: 0 OWNER ffeCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: �L CONTACT PHONE: ) (-200 -7-71 - 42,44_ <br /> ,,)o/lh'1ar'r hA vl 1 lag- e4 1 CONTACT EMAIL:jayharrtiik. I/iIIavreG(�LSU'' .tits <br /> BUILDINGPERMIT APPLICATION <br /> Existing Use of Building: ki'afttA) t I — Stt telvvt ors Contract Price of Work:$ 44j 966 <br /> Proposed Use of Building: sac-t,0 cj - (a Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ID Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: ONew DAddition DRemodel DRepair ❑T.I. OSign ineprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1M.bbt)�7,Z and k '✓)oVL ' jtm5 7`7_- fpgn1-LLR- hea f ih if-hv/j )w <br /> Add - J. v - h 4r Iu accorhodat . ructi c2:IUnys and wet/AJ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): E. I—1 I { " U3 8 <br /> MECHANICAL PERMIT APPLICATION'', " PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #ofList of Fixtures #°f List of Fixtures #°f List of Fixtures #°f 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 /> 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 SUPPR• S ON SYS M <br /> V * Number of eads Z � " <br /> ACKNOWLEDGEMENT:I have reviewed is application an, 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 gr. .of a• it 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 /> PE (# C k _��' J <br /> w <br /> Owners uthorized'Agent Signature Date (Revised 9/23/2016) t <br />