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1 PERMIT APPLICATION <br /> BUILDING I MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> • 0714-ne 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 I 0 /(°j ± 14.°t. 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 At Kcf TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET I ( /d''11 �b� 4 i4i . //�� Q% <br /> CITY ('1I ' ` STATE Ii/fi ZIP 1 117/ <br /> _. <br /> OWNER PHONE: 44444���11 OWNER EMAIL: �� 11 <br /> CONTRACTOR NAME: F+ Q,/�, Ce•/Irati4j syr. ,'t C , <br /> CONTRACTOR ADDRESS: STREET 17 7 lj A /0L IA <br /> Sf <br /> CITY / / IOC(I Ssjl.Ai <br /> STATE w j ZIP 9 3 2_7/ <br /> CONTRACTOR PHONE: q'-s 3?o - Co Z,ZCONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): veCk ), (i^ <br /> C, I Y 4.6 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):C5 /Z. 41 <br /> PRIMARY CONTACT: 0 OWNER 'ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:� CONTACT PHONE: T ZS 3'3 , �d . <br /> / _r <br /> ( " l°�` /v- CONTACT EMAIL: v Ls-cc,A 541`447, @Tree,II C i% Cg^rs <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Q c 1 Ap, 4e, Contract Price of Work:$ 30 i)C> <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ONew DAddition DRemodel DRepair DTI. ❑Sign DSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: n <br /> ft-Q.ac> f I✓,,,r,,,i) G,-, ex l S+,-� )uQ r5�zl-s S <br /> P/litao, „ c..)A" ii0..1.. c,L. 1 1a 11e/ -/- <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 7C Alteration _Repair <br /> #of #of List of Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Z Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater I Bathtub Urinal <br /> Gas Piping Boiler J 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.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 /> 71/411e <br /> 2 /I—I <br /> Yi3 oz -00 <br /> PERMIT#Owner/Authorized A ent Si nature Date (Revised <br /> 9 9 9/23/2016) <br />