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• <br /> 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 l 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: ‘.1'' ',7 L',,ke- Gkc.i)1q,:v1 Ra Monroe-PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: C.a [ A1C Eve_,-e--{-1— TENANT NAME(If Commercial): 1/I/4F(i-v-4.:49„ K,..;1;+-, <br /> OWNER MAILING ADDRESS: STREET 320(7 i <br /> CITY Plitt-l i STATE (444- ZIP Qgzo i <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: We' }tri-t Sikkts r re_ env*.e_c k o.n <br /> CONTRACTOR ADDRESS: STREET PI6 90 NE 15-#4' 54— fd.t„ /O( Q e,n 7 <br /> CITY ?eKwf.9.1✓ - STATE INT ZIP {CS �C„i,.. <br /> CONTRACTOR PHONE: 1-12,5— ¶1g1 0 t 0 0 CONTRACTOR EMAIL: 5e,�, , Z¢,.L,,,.Qe,�-- e ,�rp ,,As, <br /> CONTRACTOR LICENSE#(REQUIRED): WE51E$f406 P I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)`: 0?_0 5 3 <br /> PRIMARY CONTACT: 0 OWNER KCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: i-t2„5` 1-Li$ °LlOcL <br /> 5PiV1/4'1 2e-�v't CONTACT EMAIL: s F ,Ze tvl cia.r- i✓ ws FP , kS <br /> BUILDING'PERMIT APPLICATION <br /> Existing Use of Building: W g e FL ,,, ,c; i�F Contract Price of Work:$ (0, 000 : _ <br /> Proposed Use of Building: cte -ne.— Heat Source: ❑Gas ❑Electric ❑Other_ <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: 'Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel El Repair DTA. ❑Sign kSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: -f nf1-c,:.(4,,t.ay.� v-c Pok ZOO fkpPreit,,,� 5.),ik.- i,l c to-cA-t c /Server-- room <br /> ottt- 1 tuk-b, . <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 #of List of Fixtures #of 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 /> ' I SUPP- SSI•N SYSTEM <br /> r Chemical or Water j No.of Heads <br /> ACKNO ': 1 have reviewe. his applation and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> current fede . nd local law. The g'.-.. of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Officio .etore 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 MI # , ` of <br /> 0 ner/ uthorized Agent Signature Date (Revised 9/23/201�4�j' <br />