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• <br /> PERMIT APPLICATIO• <br /> BUILDING/MECHANICAL I PLUMBING/SIGN I SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OLT 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: fa Z x // eveisze4 dcZp PROPERTY TAX#: 019/1 t 2/90/3/9/8// <br /> j <br /> LEGAL for new construction: Short Plat/subdivision '. ,, !.,"' 4 40 (gteelirtsvfof long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: /y /L,d 6€ 7 ZC atNANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET%p;Z e9/ [ 4" 2cf, ,%' <br /> CITY r STATE J;A ZIP o' <br /> OWNER PHONE: adec. 4f A�S" F OWNER EMAIL:/14,4/6:257,01X <br /> CONTRACTOR NAME: +W /f / i(d/ de) <br /> ,57611476:. 6 <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: c6 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT:A OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: ! CONTACT PHONE: Wer,- 8' ' <br /> l <br /> evAAD � nG�!�4eD CONTACT EMAIL: w4X���rz.,Z)e 2t s-, ,4 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: , ATfi f Contract Price of Work:$ ,fit <br /> Proposed Use of Building: Nwi . ,' Heat Source:.---DGas--- iectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex Multi-Familyr#of Units: 2g ❑Commercial El Industrial <br /> Type of Project: ❑New DAddition ji.Remodei ElRepair DT.I. ❑Sign ❑Sprinkler ❑Demolition JIChange of Use <br /> DESCRIPTION OF WORK:197M- 4 > 4c/sem R /yl goc z/P"/a•G' Gr p" / . <br /> I <br /> �L <br /> M- ' --.ft,,, :,, 'ez"�= 7-9>' ;2'�1'L/0ll 71:€/a ..c/lin-7-A,;/pf 1,/, z• <br /> ASSOCIATED BUILDING PE- I (# if applicable): l <br /> MECHANICAL PERMIT APPLICATION -,, /W010 PLUMBING PERMIT APPLICATION - .j14Yii l ' <br /> Type of Project: • New_ Addn Alteration _Repair Type of Project: _New Addn Alteration _Rep tir 1� <br /> Fixtures List of Fixtures Fixtures List of Fixtures Frx#furf es List of Fixtures !: of es List of Fixtures <br /> NC-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 /> p•. Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I No.of Heads <br /> ACKNOWLEDGEMENT:1 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/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 F-05_, Only <br /> �,� PERMITa vio <br /> •r/Alit red Agent nature , Dat: (Revised 9/23/2016) <br /> c,Ak-73 <br />