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PERMIT APPLICATION <br /> 411/-1 BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 { FAX 425-257-8857 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 42.5-- 14 Ca..r/r7 C9 deQ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: S/Q/fQhj e/j7idv... ryr5'�'i c „ rIENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ' W. -, 749 ' -- P�R S hde <br /> CITY ,ip 7�' fi(9(r7 STATE Ai ' ZIP 78‘,3 7 <br /> OWNER PHONE: f...2 5 2/ --•fjy22 OWNER EMAIL:,e}-,yr7/Q1 4 ► o e I <br /> CONTRACTOR NAME: ee;4/r✓7/" cz,6/izi b../afri- <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: f:25---2/8 m 10 a 2., <br /> f"fl- if-47 L©z"? CONTACT EMAIL: S°4:2 v71e Cj.' ® j n e An <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: AlIce11 j? f'►�P. Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Units: Commercial El Industrial <br /> Type of Project: ❑New ❑Addition El Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> /Pe,Ze?e.e. 4Sp6t.6` 4.1/A e'o v7 c re& d <br /> cf ire aid <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 4 0 s',?, 7'94ft. ,ees �`� KPA) */�/otiCC�t®� <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 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.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 /> �� �Gc. A ®G-e 9 F`� P C cz T11,v PERMIT#8 / 7O —075 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />