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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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: I I- M2c;t,L.S on. 9c PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ikk tra.cl et- torts- 1/4.,15,S TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (i \5 ),.,. S� <br /> CITY `-"- " STATE A ZIP 78,®2 ka <br /> OWNERPHONE:02S) 3-4-4 —q-73 OWNER EMAIL: ID,5ZZS=SVVLSW- Gcws,A <br /> CONTRACTOR NAME: iS SI lb.L—. <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Ni <br /> PRIMARY CONTACT: gOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 9kS, .e.31/43.5 CONTACT PHONE: (-f2S - 33-(-1.. 3-2:41 Or( 2S) -34-7igs <br /> CONTACT EMAIL: wb A)"''', <br /> 7 Cv1t frj (Omit <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: VQ` ieVtC�- Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial CI Industrial <br /> Type of Project: ❑New DAddition ❑Remodel fi4rRepair DTI. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: v_ -e5*`rt. \ \- .'v'... , \ v.-` x%`-t \ �'Zvv\G,V �� — <br /> () . ` AAc�c` art c, z \Aos \.o.\o\Ds zm cJ woke,T <br /> 10 c am.. '€TJ: a.c5_, . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration /-epair _ Type of Project: New _Addn _Alteration x Repair <br /> #of List of Fixtures #of ist of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures / _ Fixtures Fixtures <br /> NC—Air Handlin Units Heat Pump [ Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air System / Unit Heater l Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration _ lir Ntelver Floor Drain <br /> Gas Fireplace / Wood Stove _ ( Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting 1 Dishwasher Roof Drains <br /> Clothes Dryer Hook:_ Other: _ 1 Clothes Washer Medical Gas , ��• <br /> Range Hood 1 Water Heater Z Other: .��kry{,� 1A056.1A056. )11'6 P`.1f_vw <br /> Exhaust Fan /1 Sink(Service/Bar/Mop/etc.) a Other: .6v, 11 ekf���ec..1e;.j a,(- <br /> t tce., i esker bo ade'4 <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 State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ,City of Everett Official Use Only <br /> / PE Ii \ �....... <br /> 00 t <br /> 0 ner/ honied As-nt Signature Date (Revised•23/2016) <br />