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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 {(E)everetteps@evereitwa_gov{ www.everettwa.govlpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:c94() H ea-filer _get Ever 7 >2O 3 ;PROPERTY TAX.#:0b 5;49 OO )(70 O <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> A CONTACT INFORMATION <br /> OWNER NAME:'g 010 d CCI,r I h ��fM C!�t Q{4�S TENANT NAME(If Commercial): <br /> ET 2` <br /> OWNER MAILING ADDRESS: snREqq-10 H eccf-herr �o? <br /> cny Ever-et ' STATE Wk ` cf 2c 3 <br /> OWNER PHONE: Li-,a5 Loa &0 OWNER EMAIL: C 1 ( C h,e r@ sp(,i. <br /> CONTRACTOR rNAME: C h uC Ic D6 OK l(/ i dRe�n a I ss n c-e u it dens D-c <br /> CONTRACTOR ADDRESS: STREET (S ��. CSrct r",--e tl C' e&i6 Rte! <br /> CITY i,,�1' I{GY 5\ STATE vv�" Zff' 'fl 3 <br /> Ri CONTRACTOR PHONE: 3(0D L 2 S•015-I V ;CONTRACTOR EMAIL: AT1 O 11' @ a O'. TI, G <br /> d <br /> to CONTRACTOR LICENSE#(REQUIRED):1 NPT 81,0 1(OM 1 CITY OF EVERETT BUSINESS UCENSE#(REQUIRED): <br /> t'6 <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> oo• <br /> CONTACT NAME: CONTACT PHONE: <br /> cow�!� IM.G�1/(Gtt�S Li t3'5 t <br /> CONTACT EMAIL: C(i Gh e p • -ea iu <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Kecpst -eVL C. Contract Price of Work: r <br /> Proposed Use of Building: P_esi deo.Ce, Heat Source: %Gas el Electric ❑Other <br /> Building Type: 1SFR-Detached CI SFR-Attached 0 Duplex ❑Multi-Family-#of Units: ❑Co • -rcial ❑Industrial <br /> Type of Project: ❑New XAddition ❑Remodel ❑Repair DTA. ❑Sign CI Sprinkler EiDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> (000 sq -64- add dY) to V�e sid ev c . ad d i v bedr-Wi, �l�I r�l k� t h C La te-; <br /> ce ayla yvv.W 0J CA lout-k-krbt5wk <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 /> A/C—Air Handling Units Heat Pump 1 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 1 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 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 WAG. <br /> _ City of Everett Official Use Only <br /> / / / j ✓ <br /> 15 ( PERMIT6 ,0! g <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />