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PERMIT APPLICATIO>• <br /> BUILDING/ MECHANICAL/ PLUMBING I SIGN/SPRINKLER I DEMOLITION <br /> "11P-0./A ----"4 <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) y,PW PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: \ 2- CfockA 'BATL PROPERTY TAX#: CCVJ'']ZZ2 C)otZOQ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 141,N p-- ?j U.-K TENANTNAMENAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET / ec 2 I `)w' X \-)C - ry�+�' <br /> 11 CITY ( ( '-- - STATEkid ".... ZIP L) �,J <br /> OWNER PHONE: t����-/�� v(.7iC/ OWNER EMAIL: <br /> CONTRACTOR NAME: //4')U (z(1` .D J) - V - <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: -jCONTACT PHONE: ( .-(7,4-7) 2< c, - �' <br /> _AL`g. Y L 1 am�._- CONTACT EMAIL: L'(,o/ .Z5 epdiAL V c7') O/ N-N G7% e''A - <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: G✓- \ 19 ( ' \ GfLr Contract Price of Work:$ "� P9C-; -1:2- <br /> Proposed <br /> Proposed Use of Bui ng: S ieHeat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached �❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel iepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ti'6j\J P ( YF ' +},- <br /> �' C�i� '�:' 2 'M c of, A-PA 11 d0.-i <br /> ASSOCIATED BUILDING PERMIT#(if applicable): PA-1 t`v7 <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 d Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting I Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> i 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.lam the owner,or lam 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 /> Ow r/Au orized Agent Signature Date (Revised 9/23/2016) ' <br />