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PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN I SPRINKLER/ DEMOLITION <br /> h 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) PROJECT/ SITE INFORMATION <br /> Lc.PROJECT SITE ADDRESS: Z7_ (ma2'4 I'kL)Q_ PROPERTY TAX#: 0O(13 5?,g S-60 2- /60 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> {I',�`CONTACT INFORMATION <br /> OWNER NAME:3QcC9(owridSe I C w( 1"`O c,e U TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1 2.2-04-01 3 Z`- O✓ S <br /> CITY G � N <br /> .)- ` STATE ��/ ZIP 9 O c 27y <br /> a-X <br /> OWNER PHONE: 3 L (2 C¢ I c 09`3 OWNER EMAIL: • 54-7a r�1.�/'iriaj•e . 5 S g_C.--a-1--i-c.4� <br /> A , <br /> CONTRACTOR NAME: <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: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: f(F� J'rty- "i d$4- CONTACT PHONE: 3 G o 4. 1. / Tom 5 3 <br /> Ll J CONTACT EMAIL: J• 9-to ,„.I -�jz „ s56_(ry,.., tI , co 4-2, <br /> BUILDING PERMIT APPLICATION( <br /> Existing Use of Building: Contract Price of Work:$ a-SO° • — <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑O er <br /> Building Type: ' SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family #of Units: ❑Co ercial ❑Industrial <br /> Type of Project: ❑New ❑Addition faRemodel 9Repair ❑T.I. ❑Sign ❑Sprinkler molit' ❑Change of Use. <br /> DESCRIPTION OF WORK: re, S'1--7..A I VI L..> L.i...04-45 0 h £le-r (ry wd" "A-.e$ cti. Qe C.C...(4 Q . <br /> 6c'' 4 4.4,`-'--j--'-I ci' i v• HSP 1- //de,-.5 I7 i., Sf-A//e of S r n Kg .c1-.,,( aiN ti.,,r A5 i 6, V-i4-vL..e,., <br /> o, -d j, ,k4 t s <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn _Alteration _Repair Type of Project:?C/ New _Addn _Alteration _Repair <br /> #of List of Fixtures #°f List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump 2, Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 'L Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove I Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting I 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 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 /> 1111A <br /> City of Everett Official Use Only <br /> PERMIT# <br /> y-1 ,. /� awco�-OVA <br /> Owner/Authorize. 't Ign ure Date (Revised 9/23/2016) <br />