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PERMIT APPLICATION <br /> '11111101.074>/:---A <br /> BUILDING/ MECHANICAL/ PLUMBING /SIGN 1 SPRINKLER/ DEMOLITION <br /> `4 CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 l(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: i 3 03 Ijo5fi 606(x/v, g oaG( PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT" INFORMATION <br /> OWNER NAME: �/Cj1c Ql d- P)doQ.� jl TENANT NAME(If Commercial): S-yG,_Q. co- Q wry./^ <br /> OWNER MAILING ADDRESS: STREET 3 73 , (,(4 <br /> l �rr �a�� <br /> CITY /c/ere# STATE /li f,�y/, <br /> ZIP Cr.,`e ...? <br /> OWNER PHONE: yi 5, 'his, 5c-72c72_? OWNER EMAIL:f Uh ecoJ €/i /114.7ady A ,,i c, O,7 <br /> CONTRACTOR NAME: /"... C4'H Pr CO/1/71A-id':cyl 1 /c_ 1 <br /> CONTRACTOR ADDRESS: STREET //err /fn--6-110e, J/� ,10,-(e 67-/7/ <br /> CITY 5e✓e, STATE jet/ ZIP g1z�U� <br /> CONTRACTOR PHONE: 7 1 O7� CONTRACTOR EMAIL: av b.. C r G/`i v� <br /> o�J6, 3 �/�y, � ,/lam � c�'isf/� c��an�cd,�, <br /> CONTRACTOR LICENSE#(REQUIRED): 7'A// Wlij CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):5V 77Q <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT <br /> CONTACT PHONE: ( /�.j7;g 79q <br /> (V �C'�r CONTACT EMAIL: a�,p- Y)„tbrG:y/571/LeLf,Gd'co,,,JGh,Y.GGA <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 0©moi <br /> Proposed Use of Building: Heat Source: ❑Gas lectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached , ❑Duplex ❑Multi-Family-#of Units: J ❑ <br /> mercial Industrial <br /> Type of Project: El New ❑Addition ❑Remodel Ie7KelD�pair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ��� D � ��(I <br /> c f L 'Cf P 3 ke-: 3 r; cic ai(,� ) <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 /> #ofList of Fixtures #of ist of Fixtures #°f List of Fixtures #°f List o-Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C–Air Handling Units Heat Pump Toilet Backf• -reventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub al <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 D -r Hookups Other: Clothes Washer Medical Gas <br /> Range .od Water Heat- Other: <br /> Exha : Fan Sink(Se ,ce/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water ' No.of Heads ......`'s <br /> • <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 /> P `i#g ( <br /> (,,,„Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />