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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)everettepsteverettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: //6 32 # 7 ; t3Y e AI\_J PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision ��JLot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): '� _ 1 —' <br /> ,�{Ypyl vo _ <br /> OWNER MAILING ADDRESS: STREET <br /> one STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <9 S^_ S <br /> CONTRACTOR ADDRESS: STREET 7/9/0 (-, --/ )- <br /> CITY Lyi 1`'r €/ STATE VIM- <br /> ZIP ,[P0.30‘CONTRACTOR PHONE: Z! .-5 �,�—p a 9 2 CONTRACTOR EMAIL,e yy�.P�( ;� .--c ip„c r m.,�, <br /> CONTRACTOR LICENSE#(REQUIRED): _ �4e.Qcf t-3.5) CITY OF EVER_ETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: D OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> p,/ , � �o CONTACT EMAIL: "rny .�, C s _,� f_ ten—,BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ C <br /> Proposed Use of Building: Heat Source: OGas ❑Electric JrlOther <br /> Building Type: OSFR-Detached ❑SFR-Attached ODuplex ❑Multi-Fa ily-#of Units: ditdommercial ❑Industrial <br /> Type of Project: ❑New OAddition ❑Remodel ❑Repair CT.!. uign OSprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> )5-f-c, 4i(14Yie ) t-e ein eOC�w/ <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 /> Fixtures List of Fixtures Fixtures List of Fixtures Fres List of Fixtures Fixtures List of 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 end 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 J 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 298.200A WAC. <br /> City of Everett Official Use Only <br /> / / �� - PERMIT#6,Ii t O�005 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) r/ <br /> L <br />