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PERMIT APPLICATION <br /> /0A1,/i -filiP1— 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 1(E)everetteps@everettwa.gov i www.everettwa.gov/permits <br /> (Blue or Black Ink_Only Please) _ ` PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: */1/ Air4,96r 1 r PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision 13/!a'.' Lot No./D/ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (- S.4eQ-)ezv TENANT NAME <br /> �`(If <br /> Commercial):/9i�j;� �lp`,S' L)e "-c <br /> OWNER MAILING ADDRESS: STREET/o2O.sr',GIJ�!/ -,2,�77- Lzz/ te)ay �,�6'2 <br /> CITY `j�d,e 1--et STATE !�6( ZIP 0,"4,Qt./ <br /> OWNER PHONE: d/ �� fir_ 2g6 d OWNER EMAIL:Q <br /> CONTRACTOR NAME: Qj7 <br /> CONTRACTOR ADDRESS: STREET i z9 ea; 34, <br /> CITY Letile c___5 .lit c STATE ZIP ,98) <br /> CONTRACTOR PHONE: ..1.,/,4S---r..j3'7-7 l/7 CONTRACTOR EMAIL: 17/ 1p J')goal&,4_,)2 � /,epi;-7 <br /> CONTRACTOR LICENSE#(REQUIRED):, I/ 7�J io 4!g, CITY OF EVERETT BUSINESS LICENSE_#(REQUIRED): JOt Lc oei <br /> PRIMARY CONTACT: D OWNER ,) CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: , CONTACT PHONE: JoZ,5-90) /QS—e3 <br /> —PQj7 i-1 a R CONTACT EMAIL: l / <br /> BUILDING PERMIT APPLICATION r:/ <br /> Existing Use of Building: Contract Price of Work:$ _ & % d� <br /> Proposed Use of Building: Heat Source: CI Gas J24EIectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex *Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: Flew DAddition ['Remodel ❑Repair DT.I. OSign ['Sprinkler ['Demolition ['Change of Use <br /> DESCRIPTION OF WORK: <br /> iii///t9"-e-- - /0/7,<'a h% h/ f7/ ficin)p <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION s 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 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 ofofEverett Official Use Only <br /> „ ,e—.0-/C <br /> PERM n l UC OL <br /> Qneir/Atuthorized <br /> arr�� Y V l Agent Signature Date (Revised 9/23/2016) <br />