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I IIII PERMIT APPLICATIO <br /> ,IIP*,/,. EUILDINAECHANICAL/ 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> sr <br /> It PROJECT SITE ADDRESS: ' /7/� %. ���� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision 4/ i �4' TLot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> INOWNER NAME: Hegile.,"" Z f ea .jj.x TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1�7/ / /11,--,"./iJe,/7/ Q,c' <br /> CITY gre e��/ /// STATE P4 . ZIP �, <br /> OWNER PHONE: 4,125-ql d -) '2 OWNER EMAIL: <br /> CONTRACTOR NAME: ,() 7. t ./ 2 1 <br /> CONTRACTOR ADDRESS: STREET /(2 7Dti f-- //&" / <br /> ars( ,filae 't ..f'j/jfft' STATE G��y1, ZIP 9. ,7C. <br /> CONTRACTOR PHONE: 4�2r- *2,7"/2 '7 CONTRACTOR EMAIL: aVr VA-L( -h S/7.7a�� Cip7 L • <br /> J <br /> CONTRACTOR LICENSE#(REQUIRED):DC/30D* rigs CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER r$1 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: %�2 - 901-1 0)1-1uorN 01st CONTACT EMAIL: 0 Via& 1-l- aPtil I1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:s V E26 C) k(000 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family #of Units: ❑Commercial El Industrial <br /> Type of Project: :New ❑Addition ,( Remodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> ASCRIPTION OF WORK: <br /> der e, Gote z 4 CCM() t n <br /> id or2y P-veDi,'r Drywal) (An LJ IL pite-L <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 #of List of Fixtures List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> i Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove 1 Kitchen Sink&Disposal Grease Trap <br /> ` Gas Range Ducting I Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> 1 Range Hood -Down drat-f:4- Water Heater Other: <br /> 0 Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER?SUPPRESSION SYSTEM <br /> Chemical or Water 1 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 /> A <br /> PERMIT#4:17/&,--.--V VI / P so q -602_. <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />