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PERMIT APPLICATIOI` <br /> BUILDING / MECHANICAL/ PLUMBING/SIGN/SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OLT 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: 37/0 WI MU it 1 l-O t_vb"Mat PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: VO)G s'j2 I C TENANT <br /> ` A .W.(_ <br /> NAME(If Commercial): SU( <br /> OWNER MAILING ADDRESS: STREET 37/0 to �U/U( I�I.OSD i <br /> cn a)G 1 �','STATE W�' ZIP 9'8263 <br /> OWNER PHONE: fr'2S 26"Z- eL—.12-(40 OWNER EMAIL: (cd il ) milli C 0 to Sca , C)Al <br /> CONTRACTOR NAME: Take, Pf j-fDQ, �U>ti c, / v 5'S, '44�t1 <br /> CONTRACTOR ADDRESS: STREET I4 c .. �� j �(L L Co <br /> CITY <CJ��-\t..E-1 <br /> 'Z��// 6. -.2, STATE IA* ZIP // i 95!6 t <br /> CONTRACTOR PHONE: 36. -.2, O CV CONTRACTOR EMAIL: Ja. /i, .COAG eyes.. CJ 'i . art <br /> CONTRACTOR LICENSE#(REQUIRED): (.� 99O 6....7- CITY OF EVERETT BUSINESS LICENSE#REQUIR a): '29\ LP <br /> PRIMARY CONTACT: 0 OWNER Ig.CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: -S-76, -7 335 <br /> 61S ' M j, f CONTACT EMAIL: ,g4 , 114C.COii i5 `b(.-fie/lir. Citi <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: FQ ��y��D Contract Price of Work:$ 2' 000.tl' <br /> Proposed Use of Building: f ola <br /> ��z.C.Y C) Heat Source: 1 Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SF -Attached ❑Duplex ❑Multi-Family-#of Units: ArCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ,Repair ❑T.I. DSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New T, 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 /> 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 properly to perform the work for which application is made, <br /> and I comply wits /e State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> / r/ <br /> PERMIT#6nhil,......,-1Ul i � <br /> Owne' '�''ori -• l ent Sign. ure D( (2. to (Revised 9/23/2016) <br /> di <br />