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PERMIT APPLICATION <br /> "Illj"—A <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> R 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: .._71o1 L N OrVG,N AVS- )er4A-LI . °lid-6 I PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1.:. c:rd TuGVe.r TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CRY �1 STATE ZIP <br /> OWNER PHONE: (Q' ` 93- Li b v1 OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION )()0 0, ()''L' }roolIC <br /> Existing Use of Building: Contract Price of Work 1-6C4)•''� $ I o Di <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family #of Units: ❑Commercial ❑Industrial <br /> Type of Project: DNew DAddition DRemodel DRepair DT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> a/ av J b J<VY'o C5o, A-- G,u S-e.l♦-- 4, s rcro W'‘, °'t^--"-- ..nu .3r r\w"E-C O etok to2 ar i-ae S, <br /> (LOl k Siv&r V cw: r c1.1^"3"1" 1 i 1 t p A OO(S', <br /> ASSOCIATED BUILDING PERMIT#(if applicable): X f l to-note ( +0Akiai p w d p,EY Yh 4) <br /> MECHANICAL PERMIT APPLICATION PLUnPERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Projec: `i' Ne _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump i/ 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 /> V., Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I No.of Heads 1 <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 /> PERMIT..y,\ID_..., 0,4t <br /> Owner/Authoriz Agent Signature Date (Revised 9/23/2016) <br /> 11DX1ltcOb (( A <br />