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PERMIT APPLICATION■ <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> 17;77" CITY OF EVERETT PERMIT SERVICES <br /> 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: /ZZs' (5Q l f z f° A v l PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Fires 0 k /10 Q TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET I /.2,Z$ )3taL& A V e c���r� <br /> CITY tl e�Q t STATE � /4 ZIP 2,C <br /> OWNER PHONE: /12.6'.-34(:?--Z /2-I OWNER EMAIL: [ V <br /> CONTRACTOR NAME: /d 1 4/b b S 071/1 5"/-6"'' <br /> CONTRACTOR ADDRESS: STREET 7JZ( (5th S7— N ai <br /> ppp /� <br /> CITY 57Le4 W eJ/i1 STATE 61///4— ZIP '7 3Z7z <br /> CONTRACTOR PHONE: L'Zj-210—57‘,..5 CONTRACTOR EMAIL: 70'7'4 46.99_5 '44(/ ,C,O vyj <br /> CONTRACTOR LICENSE#(REQUIRED): TOP?6IC4/SCS CITY OF EVERET'T BUSINESS LICENSE#(REQUIRED): 3137-x' <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �'(�e>_%' -5?os- <br /> 7w ;y as CONTACT EMAIL: ��''�ai e <br /> Com' BUILDING PERMIT APPLICATION <br /> 41 <br /> Existing Use of Building: Contract Price of Work:$ 1 bob <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ,SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units:_ ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 4/efit) U/Cz.571-@ - eU @ u C/!vi fL_ 114 $ felp <br /> O Plow S' <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 #°{ List of Fixtures #of List of Fixtures #°f 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 j 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: „.11 RI <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: Wig- i - <br /> ���,, ( $how c.v- I f a 1 e <br /> SPRINKLER/SUPPRESSION SYSTEM Iii\-6mA�/tivi?.' <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 of Everett Official Use Only <br /> �/ PERMIT#fl (CSV0e)�. cob <br /> 7.-1/` l S' ` <br /> Owner/Authorized Agen ignature Date (Revised 9/23/2016) <br />