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SPPAdi. 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 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: I i 1 0 ctgih.7. (-tU y-,- f T u& r, ' PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> / + CONTACT INFORMATION <br /> OWNER NAME: y ,,Q_ nk TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET , '1 O o�/4 A\& (f("� <br /> CITY 1/4e.._\.1 .C Z I STATE �1•(J ZIP <br /> OWNER PHONE: (/ 2-5 2j)q - `1 3-b3 OWNER EMAIL: <br /> CONTRACTOR NAME: CAA_c s,i\ A SA-i-.) tA"')oN 7-n L <br /> CONTRACTOR ADDRESS: STREET 1 7$ /: rO 1-- c-} N C. <br /> INA I y ,1_C�S'i 1 ()%.. STATEVVA ZIP _7/ <br /> C L � <br /> CONTRACTOR PHONE: 1- 7---S 3 i Q 2 2„ CONTRACTORpEMAIL: �e(`o n`5+TU C I c.,,, se <br /> e( ,,/(a/I,\ <br /> .'Q € g..c. <br /> CONTRACTOR LICENSE#(REQUIRED) 11 7 S Ing CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0'cj Z# 1 <br /> PRIMARY CONTACT: 0 OWNER bONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: q z_ 3 3©- 602. .., <br /> ` <br /> '1o` ! `5"dr\ CONTACT EMAIL: nec,,,sk N.,,I,,, _ 10,,14-)'Ct .Co M <br /> q BUILDING PERMIT APPLICATION <br /> Existing Use of Building: �LS I S1fn�1d.111 Contract Price of Work:$ 740 OO <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: .SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: DCommercial CI Industrial <br /> Type of Project: El New DAddition �2emodel DRepair DTI. ❑Sign DSprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ` / <br /> A`�"'o.L /l<v./ cl``(1%•'n SeV.3Cri cjS, e c-l-ta <br /> `1I /.4c, [0cck:ry I0 s ' (vL . <br /> I >\ "nrvt. SC04tf 1i ,t RCl,.,ur L o-( fto,,-)UTAD - �trot erg S' 1k., <br /> ASSOCIATED BUILDING PERMIT#(if applicable): `J-I ^S \)\ CL' (n Jt- bo.A / r1e.‘.1 ib..i"k r 1 ",A cl- L Al, <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of • <br /> List of Fixtures #°f List of Fixtures #of 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 3 Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> I Range Hood Water Heater Other: <br /> I 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.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# <br /> 1/\(\i‘/ V---- .11\Nt--,, 4`Z-I / IBJ A i $O a , 003 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />