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PERMIT APPLICATION <br /> BUILDING/MECHANICAL I PLUMBING l SIGN I SPRINKLER I DEMOLITION <br /> I <br /> CITY OF EVERETT PERMIT SERVICES <br /> j 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov everettwa.gov I v.w+.everettwa.govlpermits <br /> (Blue or Black Ink Only Please) PROJECTSITE INFORMATION <br /> PROJECT SITE ADDRESS: 1l1S G.4'& dew.�r t PROPERTY TAX#:: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> 4 CONTACT INFORMATION <br /> OWNER NAME:; Dcl�iec O } 0r TENANT NAME(If Commercial): <br /> OWNER;MAIMING ADDRESS: STREET l 4(( t(0 t rr {,p <br /> -inccry ` % STATE j}Wftgar 9 <br /> OWNER,PHONE: v�t+o*"GfSQ— I20Z OWNER EMAIL: O'Q,t 410 S�CIAC .1\ .C3twi <br /> CONTRACTOR NAME: (`t <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE"#(REQUIRED): CITY OF EVERETTBUSINESS LICENSE <br /> #(REQUIRED)'. <br /> PRIMARY CONTACT: D OWNER 0 CONTRACTOR POTHER(Please Specify) /tc.O(14 Sa1ckil0 l ^' <br /> CONTACT NAME: \KaoketCONTACT PHONE: 2.16,- S t --\' \ <br /> CONTACT EMAIL: y 2gb\O Q q+Y; Ctiv- <br /> BUILDING PERMIT APPLICATION; , <br /> Existing Use of Building: Contract Price of Work:$ 3 e'a W <br /> Proposed Use of Building: Heat Source: DGas Aiglectric DOther <br /> Building Type: SFR-Detached` DSFR-Attached °Duplex ©Multi-Family-#of Units: DCornmercial El industrial <br /> Type of Project: ONew ❑Addition 0Remodel Mepair' DTA, ©Sign !Sprinkler ©Demolition DChange of Use <br /> DESCRIPTION OF WORK: • c2a ckvAclak ��(-�2Y`tf tri 1 oodi 'So kfi' VK.ty <br /> `C•tu -{x�tu�w mod k t2 :‘ ta'r -\\43,- A c' ve_ N2t-j ¶; 6a., <br /> ~{ <br /> v-- 1t• c�,'w-�- clew-evAs, �q ,4 s u y t dile - .4c t (V t in, r w' <br /> ASSOCIATED BUILDING PERMIT#(if applicable) <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPUCATION <br /> Type of Project: New _ Addn -_-Alteration Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of Fixtu#ores f #Fixtuores:f #of Fixtures <br /> Fixtures <br /> List of Fixtures List of Fixtures° List of Fixtures List of 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 Gam <br /> Range Hood Water Heater O <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Ot er <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I INo.of Heads V <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and co - t Work done.ur. - 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,ori am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the S ate Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> f <br /> /1 I PER <br /> ? 2 l 1— 9043 <br /> Owner/Aut gent:Signature• Date (Revised 9/2312016) <br />