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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> "IPP44‘4:7/7.'"j 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['Coate) PROJECT SITE INFORMATION <br /> 3Do$ <br /> PROJECT SITE ADDRESS: wEsT' G.tcr1\to JZO <br /> PROPERTY TAX#: <br /> �V4RLt7 WA 4803 i�UG 4c�'3� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: gotrattr Coln ktttrct,t-L A,tcPt-,4.ert 4twvPTENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3003 c.fST C..+�sitis0 R. <br /> CITY I'VE fe f-r--- STATE 4/A ZIP g 8 20 3 <br /> 'C... , OWNER EMAIL: ata.e..KaYe Got/Ater;cowl. <br /> OWNER PHONE:CAR'int) A4�..c 4?.,5 Zkq-8N I`5 GANtCRON <br /> CONTRACTOR NAME: CT2£LM1it fLRY D. bc.grrc. <br /> CONTRACTOR ADDRESS: STREET 6q$0 S ALAS 4 J I:quaY <br /> F(ZNeAt.L STATE (JA ZIP qg2 toe <br /> CONTRACTOR PHONE: 36O-3(,t.,- 3FG V CONTRACTOR EMAIL: 304cm.- c.k&j reen herr- .c-estvt <br /> CONTRACTOR LICENSE#(REQUIRED):efrt fi V I L9 Z to M l CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):3 7.0,34 <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: .)Aso tJ Svc-1-4 CONTACT PHONE: 3(o 0 -a Z G - (41 <br /> CONTACT EMAIL: ws0n,.suc-kt9,9r«h6ervc .tooan <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: F,a.c_r-o .f. Contract Price of Work:$ 42..S 12)1. <br /> Proposed Use of Building: A/d ctfAxgxt_ Heat Source: OGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: OCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Q£PLA4t-L, tea d.TLft HtA.Ttf-j 01-1- S LoG.4•Ttrots AN 'woIry PIPlNc <br /> AS tZ(au act L1. meat 11 M z-Z <br /> ASSOCIATED BUILDING PERMIT#(if applicable): C.-\A (P' C- fl ��� FL <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 /> S 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 ' 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 /> cyst //1// PER <br /> er/ uthoriznt Signature. Date (Revi ed 9/23/2016) <br />