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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER I 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) ' PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: - grw i i-.{- Ave, i , ¢ {' ''52O( PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION. <br /> OWNER NAME: -I 1�I�Q�1 tf,(�1E. i.17. TENANT NAME(If Commercial): -j(19i�,`S 13D4-4.i�SWnp <br /> OWNER MAILING ADDRESS: STREET I S+ i 14 6* ()RI ix) �J ��}} <br /> CITY Ml�if,ttPo STATE Wig ZIP 15z 75 <br /> OWNER PHONE: 2.e)CQ V7 q o OWNER EMAIL: /11A-4A 20021 ,1",I•crxr-t <br /> CONTRACTOR NAME: /Cf &Y'Dl.+e, 'hs-Pdo 1 �/ <br /> CONTRACTOR ADDRESS: STREET tog Q 6 8 rpA V <br /> cnY g STATE W Rs/,' 0 3 <br /> CONTRACTOR PHONE: L)'a 5 -Lt 3(^4360 CONTRACTOR EMAIL:"1i Ratite( etss L�tn c . <br /> CONTRACTOR LICENSE#(REQUIRED): Cr(JR (17°(J& 1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):(fig ds q35 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR OTHER(Please Specify) � vvV- <br /> CONTACT NAME:DQUn;ate, �tti.�`� CONTACT PHONE: 2e.0`s[eQ-u, <br /> t/ CONTACT EMAIL: 90 it.),,tnion�P L7(9M'IPS •CUA <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ /16X' <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ]commercial 0 Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair DTA. jitiSign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ACA Y�(a�tG ,t;bo`1GQ.4 i�t't �/�Y�sV�Q A.1“.044*n u,wL <br /> V MII 16t' -'r Qcc;�rc� iv 66s iiiwA loraeiee,r I/4 ottekkeher , j 11 bo t t-5 i-+-tk <br /> ValAWt( ItAAS C 6) alo VID jn p a &4 t6) (tool Watt-Dm <br /> ASSOCIATED BUILDING PERMIT#(if applica le): g I ri'fl-noel <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 lam authorized by the owner of this property to perform the work for which application is made, <br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 421,/,11.e. <br /> › 170 ,_00s <br /> • , ''`ut oAgent +nature ate (Revised 9/23/2016) <br /> L <br />