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PERMIT APPLICATION <br /> LIIIP.,,,--__A BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> miliwif <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits, <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: tt`,4j w fv\f 1 k 'U f " PROPERTY TAX#; <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: f:),y-i yaTENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET VD 3 S I V ("- ' \ o V\uc <br /> CIYElk fe STATE W f ZIP 4,6 <br /> OWNER PHONE: `Z �j r--2-D.--Cit '�J( CA` � OWNER EMAIL: �+/3;,a cDc 1 �^e¢�C . C c�(� <br /> CONTRACTOR NAME: -7Rs6C�1 - Q_ ""' 3 C- <br /> CONTRACTOR <br /> J <br /> CONTRACTOR ADDRESS: STREET S 2�5 e � c:5\---, <s <br /> CITY S r'\t7' ,4J1 -.Zs\o, STATE . ZIP CA gy /C2 <br /> CONTRACTOR PHONE: X26-2: ..- (.55 2 CONTRACTOR EMAIL: stn Cv lVi Y Q(� • Qyc) G9 <br /> CONTRACTOR LICENSE#(REQUIRED): G k l..4-4+ fb 33j CITY OF EVERETT BUSINESS`LICENSE#(REQU'ED): T./01 5- <br /> PRIMARY CONTACT: VI OWNER D CONTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: =2_„2t ,..'2,,-_.--6\ <br /> 1 .3G,_ 2-10�7 <br /> <4}040,--1 --C.. . CONTACT EMAIL: ��11/�- CC=4 Covirk <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: sre_ Contract Price of Work:$ t _ 00,0 ' 14 . ;45-.°--, <br /> Proposed Use of Building: Sre Heat Source: DGas ❑Electric DOther <br /> Building Type: leSFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: DCommercial 0 Industrial <br /> Type of Project: CI New PAddition DRemodel Repair DT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: viDczaL e6..cw . o-C11/4-69.,(22 \ <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 #°f List of Fixtures #°f List of Fixtures #°f 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> • M City of Everett Official Use Only <br /> �—` <br /> -- 1 a IPERMIT W V no 013hyn <br /> 1 <br /> Owner/Authorized Agent Si.„IIEMIIIIIIIIIIIIF SiDate (Revised 9/W2016) <br />