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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 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: TI O. Eveiveem idde PROPERTY TAX#:000/0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 5-+ -I 'c. s C04 ee TENANT NAME(If Commercial): S=4-4.,,ioac A,S <br /> OWNER MAILING ADDRESS: STREET PO g,,( 3 9 q H Z <br /> CITY 4\e, ION STATE ki A ZIP/g�11 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: (,Oti441 4,1K <br /> CONTRACTOR ADDRESS: STREET )9$)3 7-7,4 /✓e, 3 <br /> ciw Kehr STATE WA ZIP 9 (�3Z <br /> CONTRACTOR PHONE: 55 3 b 3 (1I) CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): e,Er is R C41.1$3 y 30 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): S 6S 3 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR E4 OTHER(Please Specify) ,Ser-v; e... /144v,a e✓ <br /> CONTACT NAME: Lhris Lie.bed CONTACT PHONE: (� �� 3psS 3/ u <br /> CONTACT EMAIL: )2be( n G Gn�� . 4,- <br /> BUILDING PERMIT APPLICATION v <br /> Existing Use of Building: Contract Price of Work: 30/-041t 7 ,7-r <br /> Proposed Use of Building: Heat Source: ❑Gas • - = -other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: aCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: / <br /> ' p • raylg_ar f/V/'`v"ca 5crt�,>� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): S <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION I <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 /> 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:1 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.1 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 /> Owner/Authorized Agent Signature Da / (Revised 9/23/2016) <br /> �i` <br />