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PERMIT APPLICATIO— <br /> "IIIII#4 <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <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: `1 I 0 e( —c--)474k) 1 ctAe__ 'D IC S C., PROPERTY TAX#: CO 3 9 20OO 7 01 /©0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: e— j,,) r-- ( TENANT NAME(If Commercial): `A A-- <br /> OWNER <br /> el_ <br /> OWNER MAILING ADDRESS: STREET S9 0 0 £v S� V� 1klit_ <br /> CITY V4cE�- 1 STATE ZIP 913268 <br /> OWNER PHONE: (-42-c-3'3 7 Z qZ 1 OWNER EMAIL: LA t' <br /> CONTRACTOR NAME: CONA- —. <br /> CONTRACTOR ADDRESS: STREET 0 j Ni- Z cL Q�J }� <br /> CITY �� >t,0 inO , STATE w WV ZIP Y(,y�J <br /> CONTRACTOR PHONE: (-Mc '''.3.3 '''-00S Z CONTRACTOR EMAIL: tJt,X 4)t N, p�4,,,i [) •C VA <br /> CONTRACTOR LICENSE#(REQUIRED): CC'"Vk e t 0 tC44. % J MO CITY OF EVERETT',�IBUSINESS.' LICENSE#(REQUIRED): ©A4 3,,..4 <br /> PRIMARY CONTACT: OWNER CONTRACTOR La/OTHER(Please Specify)` 5 � P/'6( <br /> CL._'S,1'..i4-4ric.A/�T lL, l• 1 CONT;"CT PPONE: 9`�-S' 3 57 —1 q 2__I <br /> L <br /> CONTACT EMAIL: /$i,D144 sb4/@Sh4 �•eb!� <br /> BUILDING PERMIT APPLICATION V <br /> E sting Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: I2S`FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair DTI. ❑Sign ❑Sprinkler [ molition ❑Change of Use <br /> DESCRIPTION OF WORK: Z 4 14.1 S'EVC <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 l 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 a 296.200A WAC. <br /> City of Everett Official Use Only <br /> � PER <br /> # <br /> ' 7?-4,....... <br /> i'�/6 PA 171`70(0 - 069 <br /> Owner uthorized Agent Signature J Date (Revised 9/23/2016) <br />