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PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN/SPRINKLER/ DEMOLITION <br /> 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 Please) Co) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: i Co 0 [:• 6lhtd 4 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: fkAa taA. `,,I A COV TENANT NAME(If Commercial): fr <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE - ZIP <br /> OWNER PHONE: ,J� OWNER EMAIL: <br /> CONTRACTOR NAME: c61 s*S;Su i Gt.. �✓v J- <br /> CONTRACTORADDRESS: STREET 24 kYZ- C 0ILa AAL n <br /> CITY eArer '�"'`+" STATE VII.. ZIP 9 .Y z 0 / <br /> CONTRACTOR PHONE: t'IZ 3`. 43,i _ 9 35-0 CONTRACTOR EMAIL: l f�S. (8 <br /> CONTRACTOR LICENSE#(REQUIRED): C C FP's STS V 8 3 Z.) K- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0 x630 p <br /> PRIMARY CONTACT: 0 OWNER taCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ({Z 5 ,e (43J2. °I 3`0� <br /> J v 1 l.\ CONTACT EMAIL: d X (4 I C STS Sits • Co✓A. <br /> BUILDING PERMIT APPLICATION (, ✓ <br /> Existing Use of Building: Contract Price of Work:$ 3 y S / 5-, - <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: CZCommercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel El Repair DT.I. 1Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 0 1 i <br /> rowa-u o \-4 r - 8ol,vti. S Bbl/ t tub (�t CGi C`t I <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 #of List of Fixtures 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 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> qlft, <br /> 10(o — 004 <br /> Owne I nt Signature Date (Revised 9/23/2016) <br />