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PERMIT APPLICATION ' " <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> I'11'11` CITY OF EVERETT PERMIT SERVICES <br /> • ritgi- <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) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: C) 2`' fic Le,."r PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> a <br /> OWNER NAME: L) a'i'l ,i 1' ,A, / -e !f:eor ;,,;;//,'c TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Q M2 3 Y <br /> .'.tf07a"" ! CITY STATE 1.:.',i2: <br /> , ./9 ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Ke, iI'(_ d`, <br /> '' � 64. tWi lied.), ilii c"'_ <br /> CONTRACTOR ADDRESS: STREET :%.g .5'2(:' i`. C. II t/k& f q -- <br /> °E"jo(i 7-0-?-1 CITYSTATE 'j/9- ZIP to --... <br /> CONTRACTOR PHONE: f v '4C,I .7 ° - L. CONTRACTOR EMAIL: IQ 0 O © Di 11(-0 <br /> CONTRACTOR LICENSE#(REQUIRED): ;;y 0/iii f"`.X P") l ..(4,,-- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):`" 8�b <br /> PRIMARY CONTACT: 0 OWNER [Q CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L-1 2 5:— 2)---y. - 47 5 A Li <br /> 1711l''-;e- E °c� CONTACT EMAIL: 'd F' ci t a, rFt" .: ".e<.1r? <br /> BUILDING PERMIT APPLICATION <br /> CO <br /> Existing Use of Building: Contract Price of Work:$ �W�• <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition DChange of Use <br /> DESCRIPTION OF WORK: <br /> (A‘A/1/14tgtV <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 M7, Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 17 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 f <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood 3 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 1Use Only <br /> ; PERMIT lt,.) ..---i <br /> zicv/i <br /> Qivner/Authorized Agent Signature Date (Revised 9/23/2016) <br />