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PERMIT APPLICATION <br /> BUILDIN t) MECHANICAL I PLUMBING/SIGN I SPRINKLER I DEMOLITION <br /> #1.' CITY OF EVERETT PERMIT SERVICES <br /> 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: 2 CO/h,v Ave. #2,—C PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision J Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: hc /7yu h ,77->/26,_ TENANT NAME(If Commercial): i, A -1 . o <br /> OWNER MAILING ADDRESS: STREET -)--6.)- c/1j A v-e 41 -1-C <br /> CITY r(/�/r* I1--t STATE IN ill zip 9�'. -O / <br /> OWNER PHONE: 1/- --- cti2 _ l OWNER EMAIL: , /Uh r Al V(c)( 'f` CG 0 yryvi a 1/ , C 0Gll <br /> CONTRACTOR NAME: r r r " L Q <br /> CONTRACTOR ADDRESS: STREET --)-G)-t- C p`,6r, 4 I,e * i-- C <br /> CITY 1i2,--e-- / STATE IA)A ZIP 9 O -o / <br /> CONTRACTOR PHONE: 4/-2_, g- / -L/ CONTRACTOR EMAIL: LILTYZgO6A'io/74 2 j-14A01 /t earl <br /> CONTRACTOR LICENSES##(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): t--.3"/�t1" <br /> PRIMARY CONTACT: LL1 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: t� / `�— CONTACT PHONE: e/....)_&--_- 1 - 79 / <br /> /v i Ai,k 7--) J (it CONTACT EMAIL: (16?ny , ,.., j, f q a.3" a i A 0 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: C C'ice e s Al' ) Contract Price of Wo :$ <br /> Proposed Use of Building: Ca e-Q ci..e Heat Source: ❑G. Electric OF Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Uni.: I .mmercial 0 Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair CIT.!. ' Sign ❑Spri ler ❑Demo' on ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> GU /L/ S( V► , keer(>< --LO 0" <br /> o <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 #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures 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 /> 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 /> PER <br /> ?/, Z. r 8- LRS .—o( 0 <br /> • <br /> Owner/Authorized Agent Signature Date (Revised <br /> 9 9 3/2016) <br />