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if <br /> PERMIT APPLICATION <br /> '11114141/1t%//;---- BUILDING/MECHANICAL/PLUMBING I SIGN /SPRINKLER/DEMOLITION <br /> 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: 36 Z5 Areoelhatit PROPERTY TAX#: 9300 it <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ,*4 S4-Wb�r(,�,s t ,TENANT NAME(If Commercial): c -4, -b,/Ckc <br /> ,_OWNER MAILING ADDRESS: STREET ‘101 Q a . 391.1 9 Z <br /> cn, Sept STATE 1,/ ZIP j J Zy <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: tei)4G6 /tit/ <br /> CONTRACTOR ADDRESS: STREET /973 3 7g ?ZH 1 ✓� S <br /> CITY iteY,...j. STATE WA ZIP 9 903 Z <br /> CONTRACTOR PHONE: $55 363 kit/ CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): 164404 H j 14 3 D CITY OF EVERETT BUSINESS LICENSE#(REQUIRED.S6 Fs 35 <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR EI OTHER(Please Specify) Se✓✓u-e- /444,44.10,- <br /> CONTACT <br /> tin45PrCONTACT NAME: cH✓;S `I ,l,e, CONTACT PHONE: q g 3 9t 55 3/1-3 <br /> CONTACT EMAIL: CLIebe, rJ. (,e54,..Al✓.WYh <br /> BUILDING PERMIT APPLICATION �( <br /> Existing Use of Building: Contract Price of-Work:$ �gS�. /1. <br /> Proposed Use of Building: Heat Source: 0 - lectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: IF/Commercial ❑Industrial <br /> Type of Project: El New DAddition ❑Remodel ❑Repair DTA. ❑Sign El Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Ize pl b �- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn LAIteration _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 /> I 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.lam 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# <br /> rV rV/l 0417(0 "- I -�^� <br /> Owner/Authorized Agent Signature Die (Revised 9/23/2016) <br />