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PERMIT APPLICATION— <br /> #0," BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 j 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 /> 5D e <br /> PROJECT SITE ADDRESS: 0.4 i 0c/4_6-Peltier-er- 6 PROPERTY TAX#: 00 4-9 rj 000/00 4100 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:0 1-1.i Orb , - S"i f/1,fin L, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 6300 k0cke LCQY Ave, }� Q' <br /> cm( 69t�" / STATE vv )' ZIP q``�D3 <br /> OWNER PHONE: ;©4 ^ 31/ — Z2(v 5�' OWNER EMAIL: t:�Ott:6'6/0X 2/ eget/700, Cm9 <br /> CONTRACTOR NAME: . 7(�)L./-e-"-1 "-J <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2_D 4 ?-/ 2-2 <br /> 11%- <br /> ®L,f J pswitir 2 G/ CONTACT EMAIL: ✓G'�pj`Q,91.4,7 777 c >�a J ' - G <br /> BUILDING PERMIT APPLICATION <br /> IR <br /> Existing Use of Building: 5;de �t lbvi1�'[-i is✓!rj Contract Price of Work:$ (.1300Proposed Use of Building: 9LM i t Pao/A-c� 2 Heat Source: ❑Gas 32klectric DOther <br /> Building Type: ' SFR-Detached ❑SFR-Attac ed ❑Duplex ❑Multi-Family#of Units: DCommercial ❑Industrial <br /> Type of Project: ONew DAddition ereemodel DRepair DTI. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> /1/044 -C, 4 -./-0 ex-7�nq iro < - ee--/ A75'-7-45441e- e'P AIremen4- <br /> 71w ,t-- 1.71-,-P4 irki2y bb rri•6 .h ‘eix-f�/7 v� izn p , r? , A 1-(S A C., vef-)7 j ex i l r-�9 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): Air-7)'t'1 ^/ Y�Yr ' " a bed( <br /> ovnl <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 #of List of Fixtures #°f 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 /> 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 wi -te Contractors Law 18.27 RCW and 296.200A WAC. <br /> (City of Everett Official Use Only <br /> 9` / /2---16)/4- <br /> PERMI(i1�0. ' Ca <br /> Owner/Authorized •gent Signature Date (Revised 9/23/2016) �� <br />