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IIIr PERMIT APPLICATIO II <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN RINICLER/ DEMOLITION..+� CITY OF EVERETT PERMIT SERVICES <br /> N�_ 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: 3 2 7 (—PAO ' A-OE PROPERTY TAX#: SQ€ S t- IQ ,.,n r> <br /> LEGAL for new construction: Short Plat/subdivision S ee_ 5 1A-e. e f ct'1 Lot No. (attach copy of long legal description) <br /> l� CONTACT INFORMATION <br /> OWNER NAME: c Qt/t.V(c S TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET \1,'-\k `V & J CO 1c2 ' <br /> 2_ <br /> CITY (..--\ Y>✓1 O 00 8 - STATE 1 V"A- ZIP c- (2)o3+5. <br /> OWNER PHONE: '---3(.,„0 (-1,2,5 5. OWNER EMAIL: S0u\fi)1-G g. G,f(peVA .t�c&Ve-�f'9?ei-4-y- cc,---\ <br /> CONTRACTOR NAME: • C 1,,.. 2......., d <br /> CONTRACTOR ADDRESS <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT:�WNER ❑CONTRACTORTHER(Please Specify) i L� �.!kJ 20� 3 22U"-- 4 <br /> CONTACT NAME: CONTACT PHONE: -2.n 3'L( 24) 5-7 <br /> \ ' >1r ) CONTACT EMAIL: /1 .2\ l"' ltLci7wo+/eEpp-ckI-y n / \ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: SF 2- Contract Price of Work:$ bD DO.ED(- <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: DSFR-Detached I ER-Attached 0 Duplex DMulti-Family-#of Units: DCommercial 0 Industrial <br /> Type of Project: DNew DAddition 10Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition DChange of Use <br /> DESCRIPTION OF WORK: �` 1'� ,�� cv - (�J Z' <br /> ��VC day�.-�- c-1\0'1' ,., .-- � �.-A- , / P <br /> >-s U til-- P-79 fl-k,vj e - z .-Ce_e,-(- <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 Fixture #°{ List of Fixtures #°f List of Fixture <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat• p Toilet Backflow P ,-nter(Inside Bldg) <br /> Forced Air Systems it Heater Bathtub Uri <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Dispos. Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Drye 'ookups Other: Clothes W.- er Medical Gas <br /> Range H...d Wate eater Other: <br /> Exha Fan S' (Service/Bar/Mop/etc.) Other: <br /> •INKLER/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 /> . • comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> • 0 --- PE7 <br /> OwIMILITr orized Agent Signature Date (Revised 9/23/2016) 7' <br />