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PERMIT APPLICATION <br /> /111°P BUILDING / MECHANICAL/ PLUMBING /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: g to r1-1,iL'nre.nV / +q. S7"-- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 6 4.-!v , e_rpa1..-.7.1 70 TENANT NAME(If Commercial): 70 <br /> OWNER MAILING ADDRESS: STREET 2 3 Z 17 ._'9 z t r-19Jc t�vok . ,7-- <br /> an' V.ze-17.-4,-r—) STATE i"J 4 ZIP al t jze.? <br /> OWNER PHONE: \\ OWNER EMAIL: <br /> CONTRACTOR NAME; S �0 L1r1 t`i SOA-)_ <br /> CONTRACTOR ADDRESS: STREET Z 1 Y2 a 1 C( fW -S'T S inJ U.)/1- <br /> -- ii4 614 t TE. \"a( <br /> tCITY y r J%) ? V!fit STATE 4J q ZIP 115 03 L <br /> CONTRACTOR PHONE: 4 7 5 -''13i .i}Odi'Z_ CONTRACTOR EMAIL: el...4143eiL. lu i CI 01 S rt•Ad , •1 ej <br /> CONTRACTOR LICENSE#(REQUIRED):'D1 p L S L el 3 4 L K._ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):(9 5 200( 1 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> C CT NAME: CONTACT PHONE: gig Z - 4 Li - (o 3® v <br /> C� V I V per^*r P _ CONTACT EMAIL: ( P <br /> VI & �--� <br /> AJl �� � 0ld-roKSnw ,Kew <br /> BUILDINGPERMIT APPLICATION <br /> Existing Use of Building: 0FF►C I Contract Price of Work:$ 1 Z P L2 <br /> Proposed Use of Building: 7?f ie. e; Heat Source: OGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel El Repair f) .I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> (.1 OrLsosC £ b1JE 1) 7t r.,i,L <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 I 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 St- ontractors Law 18.27 RCA - d 296.200A W C. <br /> City of Everett Official Use Only <br /> PERMIT# r.---n <br /> Q' <br /> � <br /> :6017.-- ' thorized;,gent Si.n, Date (Revised 9/23/2016) <br />