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PERMIT APPLICATIO <br /> BUILDIN�CHANICAL/PLUMBING/SIGN RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa,gov( www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT sire INFORMATION <br /> PROJECT SITE ADDRESS: C11401 SinalrO V)t EVA "- Wil jt2-Oct PROPERTY TAX#: O O S3-1 t oOOD 3 70O <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> f <br /> OWNER NAME: 4\SO'C�.Vld UrrV4-La-MQ iCLtaCC( TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET "m 01 S'v CX rro 9 r <br /> CRY Eve r0-4- STATE WA ZIP q J)Lj <br /> OWNER PHONE:(925) 750—q0L/ OWNER EMAIL: 5 US%u rru IG2qae mal/. COQ <br /> CONTRACTOR NAME: (CI W 1 Qk--- <br /> CONTRACTOR ADDRESS: STREET <br /> CRY - 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: CONTACT PHONE: ( LI ZS) 7E0- <br /> 7 E0— uoC/g <br /> a�'n Q,r CONTACT EMAIL: <br /> SSS�U rr�d 2y r- z�'')G i I. C 0 el--1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: No hQ Contract Price of Work:$ 000 <br /> Proposed Use of Building: S4-OraQQ., Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: R(SFR-Detached ❑UUSFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: dNew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ��,; ovt�� ct 442.--ACinQGt Ctr-a e to j ©W neve <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 /> It of List of Fixtures #of List of Fixtures List of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—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 I SUPPRESSION SYSTEM <br /> 'Number 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.tam the owner,or 1 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 Use Only <br /> (-' SCq r3 16 l( o 9 OkL( <br /> Owner/Authorized Agent Signature Date (Revised 5/20/2016) <br /> )Z <br />