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PERMIT APPLICATION <br /> iliSiffirBUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) <br /> i PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ‘31-\ VAQ Iv X.\.J.9.. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: P-)6(1/41A ?)v& Y40 a os \y C* pTTENANT NAME(If Commercial): <br /> OWNER MAILING ADS: STREET i'5‘.°1I-\SLi` '1 <br /> CITY St_Y9 , STATE W‘...4 ZIP D,O 1 <br /> OWNER PHONE: OWNER EMAIL: (2_v QVC � b oo•-\\- 6--2%,(-\. (oi <br /> CONTRACTOR NAME: ri\(k ' C \ 3 ! � <br /> CONTRACTOR ADDRESS: STREET a1 1 ' • 't-V 9.yQ_& i.").Q <br /> CITY - stsY skSTATE W A ZIP GI g'o-O I <br /> CONTRACTOR PHONE: 4 ..S, — (meg() 1 CONTRACTOR EMAIL: {MVS\,60 F I 0,01 1, CO cy <br /> CONTRACTOR LICENSE#(REQUIRED): C. 4 1(0 ei ' CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (A ,triG 11 t. <br /> PRIMARY CONTACT: El OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �a�- S k•- __,.__.9'a.-}� <br /> 1o_kA Psis <br /> CONTACT EMAIL: �U Q,rQ- --Q .bu\(„ \m , cc r <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ ( VC() <br /> Proposed Use of Building: Heat 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 ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> a IAA) fr,AAA ol- ,r <br /> ,40_, <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 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 /> p <br /> City of Everett F <br /> Official Use Only <br /> ( X0 \ , Si (26/(i PERM'' l -719 -0 6 ( <br /> Owner/Aut orized Agent Signature V Date (Revised 9/23/2016) <br />