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PERMIT APPLICATIOM I <br /> Cfr,--% BUILDING / MECHANICAL/ PLUMBING /SIGNSPRINKLER/ DEMOLITION <br /> .. 4',::::77_ _ CITY OF EVERETT PERMIT SERVICES <br /> • <br /> 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 Please)�tPROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: v.S V/ t L�J O77 / PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: yry,(,f�<-/ p0 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRES . STREET/ // - s ,',Y- <J'- 2 / <br /> CITY Cal-c71--g <br /> J��r G STATE 7, Y <br /> OWNER PHONE: / /F b O -g/6' OWNER EMAIL: % ig ,. �tf <br /> r�l aa-26,4,A9/A5/C91,1,-,1714 <br /> CONTRACTOR NAME: d`"' <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: MoruWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> COy.,4 <br /> TACT NAME: CONTACT PHONE: 6 ‘17 ---(9- 17/:(U <br /> rt � CONTACT EMAIL: � %�l• t � <br /> BUILDING PERMIT APPLIC TIO <br /> Existing Use of Building: Contract Price of Work:$Y><�U 66©. <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:' �f 4,� 476f-ML.///' 0," ,2 .J ^may j is djfj� <br /> P� e-%°rs, o er eee4 (((///��c,/_c_exi (/ <br /> ASSOCIATED BUILDING PERMI"N#(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 #of List of Fixtures 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 ( No.of Heads • <br /> ACKNOWLEDGEMENT."I have reviewed this applicatiot -nd 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 granti • • a per t only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized .er any circu' tance.l 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 th-State Contrac• Law 18.27 RC and 296.200A WAC. <br /> City of Everett Official Use Only <br /> V3 r n PERMIT#e t S0^ o\Li <br /> 0 horized ire Date (Revised 9/23/2016) <br />