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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> N 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 /> Iue or Black In Only P1ease)= PROJECT. ITE INFORMATION, °� .7 m / / , , <br /> r <br /> OJECT SITE ADDRESS: (T4D E j PROPERTY TAX#: Gaq3/O0Oc .f3'tcGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: D—AAJC-`37— f '/aC6.%f TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ,,--k06. C,49 V ED <br /> CITY eir F77! STATE W A- ZIP R 8-at <br /> OWNER PHONE: a g 17—g E/9 ONER EMAIL: <br /> CONTRACTOR NAME: Did-It 2i—r FL. d <br /> 1,46Gz -1.4-T-6- <br /> CONTRACTOR ADDRESS: STREET /6(0/q /3A-4 �v,e_GO • <br /> CITY L-WM,OCC2D STATE wA- ZIP‘ i8(0,57 <br /> CONTRACTOR PHONE: 4Z5-775-6;L/6,4 CONTRACTOR EMAIL: $€ QO4.y/PUJ /I <br /> CONTRACTOR LICENSE#(REQUIRED) DA4/1Q. -1)1-4-614 L�Ji?Q CITY OF EVERETT BUSINESS LICENSE#(REQ ED) G 19-2 t( <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L{271S (�(o <br /> C_ Co (/ <br /> EJ I / � w _hq / SLI FP CONTACT EMAIL: 7 /,,v,, eDAN ASID A)CTE,yU- - <br /> ., <br /> BUILDING PERMIT APPLICATION, ,g. . ii.,, <br /> dd <br /> Fisting Use of Building: Contract Price of Work:$ �//%aVt 0-0 <br /> -4oposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: ❑SFR-DetachedFR-Attached 0 Duplex ❑Multi-Family-#of Units: DCommercial 0 Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ODemolition OChange of Use <br /> DESCRIPTION OF WORK: ,,/57-4LL._ N`etA2 pre4 vbr5, w L cs-��J� 2 <br /> Die- <br /> G1TY ateT yr TH-e_ 1-er1-2-, <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 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 I Other: I',1/,Kj 2 5 thew C,E <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER!.tiSUPPRESSION,SYSTEM <br /> Chemical or Water I No.of Heads <br /> KNOWLEDGEMENT: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 /> trent 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 /> ilding Official before being authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> d I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 'OP , 4 44 I PER Q <br /> of - -06 g <br /> Owner/Auth zed Agent Signature ' Date (Revised 9/23/2016) <br />