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J <br /> PERMIT APPLICATI1119 1 <br /> BUILDIIIU / MECHANICAL/ PLUMBING /SIGN I—SPRINKLER/DEMOLITION <br /> "Ija. <br /> 1 _ 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) PROJECT,SITE INFORMATION <br /> PROJECT SITE ADDRESS: s Evecrt n!en (,JAY (PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: L� lr TENANT NAME(If Commercial): cn!A Akeye r <br /> OWNER MAILING ADDR STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: 1 OWNER EMAIL: <br /> CONTRACTOR NAME: En8ttr1ee'r�ee S4rus` es Inc. <br /> CONTRACTOR ADDRESS: STREET 3 3(7 - Lf, t 174x%u e 0 S�t 3 <br /> CITY Alegi Z t a r • STATE 1,D ZIP g 3 . Z <br /> CONTRACTOR PHONE: ISZj IS.-‘7q^gt7oS CONTRACTOR EMAILTprc Kellahwr 0 1Z.g 1-Ex,- . +0-1CONTRACTOR LICENSE#(REQUIRED): V( SZ g',vs 11 . CITY OF EVERETT BUSINESS LICENSE#(REQUIRE I :oq gap% <br /> PRIMARY CONTACT: 0 OWNER ,0'CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 1. CONTACT PHONE: G"�w3ur (1'7q^Gt7o$ <br /> Tr 1 like Ile1\Pr CONTACT EMAILc'3'den`�+� L.1Ihelf1a(' 1:\-Cv.7reP,S .Com <br /> BUILDING PERMIT APPLICATION (-7- <br /> Existing Use of Building: Contract Price of Work:$ ZL14f TOO <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑ ther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units:_ ❑C mercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ,2Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> \ACtMer- oc— enNry doors or 4wo eMra,rcea <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 List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—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 to Contractors w 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ht1-1-1 PER # <br /> n ut orizetagent Signature Date (Revised 9/23/2016) <br /> I <br />