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PERMIT APPLICATION■ <br /> d <br /> BUILDING/MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> isCITY 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: 5Q lot (- 11cJs r e AN hfc7 PROPERTY TAX#: c o5t 906 d b /70a. <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: a a,,k. c P A►M r-1'c TENANT NAME(If Commercial): 13Gr E a( )9vNNr,'C'G <br /> OWNER MAILING ADDRESS: STREET (C7 I hV )r yo n Si- e <br /> CITY \ )NC1 r A STATE 'JC ZIP 2825s- <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Lf eS 1-mc„r Co r\S�rt c- -I'nr. <br /> CONTRACTOR ADDRESS: STREET 6 )o`� © - L Q t ' Sf r e F t-(OCb (� \� <br /> CITY rra�+d r,-, r STATE w� } ZIP -{• <br /> CONTRACTOR PHONE: .3-S 6t(.. 96-3.6 1 CONTRACTOR EMAIL: f i't, e wt'ST-l`.G.1^r <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIR'D): <br /> PRIMARY CONTACT: 0 OWNER ISI CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: -(3170 -0Z5 CONTACT PHONE: ,a53 561.1 (46�6W4,4 <br /> Tc N'N FSC r, CONTACT EMAIL: Tz ,r,,, G' t.✓eS1-rrcr t r©/'Sl'. COWS <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Wor .$ 219C0 <br /> Proposed Use of Building: Heat Source: ❑Gas • ■• •- <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition El Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑1Change of Use <br /> DESCRIPTION OF WORK: fie loc r _ 1 at, 4 ` )e� �; /-b ex is'.•''Irl` re s 'roo Wl. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICA •N PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn _Alteraf _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures # List of Fixtures• #°f List of Fixtures #°{ List of Fixtures <br /> Fixtures F ures Fixtures Fixtures <br /> A/C-Air Handling Unit Heat Pump 1 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 1 Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater, Refrigeration Shower Floor Drain <br /> Gas Firep-ce Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas R ge Ducting Dishwasher Roof Drains <br /> CI. es Dryer Hookups Other: Clothes Washer Medical Gas <br /> ange 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 /> PERop <br /> ^ r r <br /> 4-41 t 1- �-�- , I � \ 0 <br /> Owner/AutI e --Signature Date (Revised 9/23/2016) <br />