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PERMIT APPLICATION <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: ZO((o 13q ge_ PROPERTY TAX#:QO'f O(S'(((O2 riso <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ;(.( row e TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: SIREE I ZD( (v but tZ - Ave. ' - 4/52.0 <br /> o <br /> CITY F`/'G,Y'tr. STATE (Ar ZIP 9 0 2.0 <br /> OWNER PHONE: 1-{25- 2 5-2- cf I3 OWNER EMAIL:c<na.rs v c'h�ret �o j� �l .Low. <br /> CONTRACTOR NAME: .o Ne( <br /> �� Kb(c �e -f'�N� 01 T.v.c. <br /> CONTRACTOR ADDRESS: Sim E I 35"/5.- ' 10� 5.6 <br /> CITY L`lt� 5'f�G/' M5 STATE (4)/4 ZIP 1 p Q <br /> „2, <br /> CONTRACTOR PHONE: 1475 -33 y-8'7400 CONTRACTOR EMAIL:cj1„,IC c nd(q btck :nvAna •01."p"n ,rv,a, <br /> CONTRACTOR LICENSE#(REQUIRED):AFFO R HI 9(0 KE CITY OF EVERETT BUSINESS LICENSE#(REQUIRED <br /> PRIMARY CONTACT: 0 OWNER .®CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:1(2-S 33 y. i 00 <br /> ar(cS 666Irak o„N CONTACT EMAIL <br /> : _^ �Jy' <br /> .v�ck� �IZTor ed(',jonvA (•r7 ;+.lc,cool <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 5� rAw.;(y K&SI- Cenc_& Contract Price of Work: $ Jf3130.- <br /> 13 <br /> Proposed Use of Building: t Heat Source: ❑Gas !:' lectric VA Other_ <br /> Building Type: ❑SFR-Detached asFR-Attached ❑Duplex ❑Multi-Family-#of Units: 0 mmercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair gIT.I.? ❑Sign ❑Sprinkler ❑De .' on ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Zr.14 t' duct(eS5 (- a fume Sy e_r-k lin Z 1.1.cr-#4 <br /> EI eeti.-4,,,A 19/ e <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 I 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 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 of Everett Official Use Only <br /> PERMIT ff_ <br /> C o e. 110.1 . /1-2-20t7 ` �( -- �� <br /> Owner/Authorized Agent S' nature Date (Revised 9/23/2016) <br /> 6 <br />