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PERMIT APPLICATIO <br /> BUILDING/MECHANICAL/ PLUMBING /SIGN INKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> • OrETT 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 <br /> Please) -PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: /. &CO04I. OT PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 9.9)._ Al gY 1 <br /> CITY I�fl{r�C� J STATE LA ZIP /(/.�� <br /> g©�/ <br /> OWNER PHONE: I✓��• OWNER EMAIL: <br /> CONTRACTOR NAME: ¢fpQ.L. icNsf:e-i-- Torri <br /> CONTRACTOR ADDRESS: STREET /434 <br /> L <br /> t�( ,k VC'' <br /> CITY py) STATE W A ZIP 7 a-4 <br /> CONTRACTOR PHONE:C.,k)-— e,'.410 r CONTRACTOR EMAIL 61gS I' � ~7. <br /> �-I <br /> CONTRACTOR LICENSE#(REQUIRED): YEA ' DS CITY OF EVERETT BUSINESS LICENSE#(REQU ED): 5t--k0 <br /> PRIMARY CONTACT: 0 OWNER IONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: C7 () -VA$ .._y/9,1f, ) <br /> coo �°` CONTACT EMAIL:d� =al.L+"14cS - C'c-�✓f a-66 A c-0,4 <br /> BUILDING PERMIT APPLICATION y�,, <br /> Existing Use of Building: Contract Price ofa. Work:$ 000 <br /> lk <br /> Proposed Use of Building: Heat Source: as ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial El Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair DTI. ❑Sign DSprinkler ❑Demolition range of Use <br /> DESCRIPTION OF WORK: Rp(�e 1 il.e C -) <br /> p e.„,; -°h ��4 ( 1 ) V1 <br /> s 11 e e-c -�L _bile <br /> 'V tAVA i fA <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 #°f 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 /> 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 /> _ PER T# <br /> . !'arl� /.�'►��/ /6 S -c <br /> Owner/Authorized Agent Signature �� Date (Revised 9/232016) ) <br /> ,_ ',2 <br />