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PIERM1l'APPLICATIC= <br /> ,r' :UILDI�h 1 MEC'r,ANICAL I PLUM:IING I SIGN I SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> • A_M_ 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blase or Black Ink Only Please) , PROJ CTSITE INFORMATION <br /> PROJECT SITE ADDRESS: ezi <br /> ( • feIO i -l ;' - f PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONT CT ITORMATI•N <br /> OWNER NAME: G,kSr o4 l WSJ/TENANT NAME� � (If Commercial): <br /> OWNER MAILING ADDRESS: STREET ,7r (JZ 4- 4.G r—- iVIE– c��.. <br /> NA) <br /> CITY 7c j `• STATE -W ,_z) ZIP *! <br /> OWNER PHONE:NA) 15 2'/ OWNER EMAIL: I'�k \ `/V�= <br /> CONTRACTOR NAME: ..S - `L) +_) i _ i 6 ac_._ <br /> CONTRACTOR ADDRESS: STREET -t U(t--' / J 'V -si •-1C2 <br /> e CIN .�v STA/;� (/tj ZIZIP—)g <br /> CONTRACTOR PHONE:( 5J ( CONTRACTOR EMAIL: -I'I!Th 4{be1 X88 <br /> CONTRACTOR LICENSE#(REQUIRED):/ C,„c35-1.8 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> (421._.C)PRIMARY CONTACT: 0 OWNER ,CONTRACTOR 0 OTHER(Please Specify) (It( kt ti <br /> CONTACT NAME CONTACT PHONE: (PCS r' LID <br /> Trfta A) 609 1108461CONTACT EMAIL r�� 1 �e4 <br /> / � BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 1���,,,,{{7��/1�i� Contract Price of Work:$. �'' <br /> Proposed Use of Building: 1/14V,--- Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ['SFR-Attached ❑Duplex l' lulti-Family-#of Units: ?Cit; ❑Commercial El Industrial <br /> Type of Project: GI New DAddition celiemodel ❑Repair ❑T.I. ❑Sign ['Sprinkler ['Demolition ❑Change,of Use, <br /> ti <br /> DESCRIP ION OF3WORK 4> ,, .r Ire'I /i° �/, I^ / <br /> V4cAlekici&O f .4416 sflsgiC. - <br /> ASSOCIATED BUILDING PERMIT#(if applicable): /ria <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 /> 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 /> 2-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 r 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 befor-1being 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 amply with the/tate Con -ctors Law 18.27 RCW and 296.200A WAC <br /> (, l� �1 City of Everett Official Use Only <br /> �; ti <br /> 140lfL�Ii f�ri � /1/12-4/24 <br /> ' .1101, <br /> 3 <br /> 11111T# <br /> l( f� <br /> Owneic/Aut orized Agent'.ignature Date / (Revised 9/23/2016) <br />