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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 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 36 15 ti.-0" r'trei. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION ,�/ , <br /> OWNER NAME: ' 6 TENANT NAME, If Commercial): Obs U►i , t ) /d . <br /> OWNER MAILING ADDRESS: STREET ' '�mat■:±_s,f-4IC�'A ►r # ��' v` A ,' <br /> CITY 1.-11. <br /> STATE ZIP <br /> OWNER PHONE: —OWNER EMAIL: <br /> CONTRACTOR NAME: F•i'Wi' 1 —• _\/,J al i` Vee/i <br /> CONTRACTOR ADDRESS: STREET 2 u v'�' \ �✓4A„ /'/ <br /> CITY STATE lit Id ZIP qt(2-0 I <br /> CONTRACTOR PHONE: 14 (Qkr oinp CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: ,Q CONTACT PHONE: L� ll°J - 61113 1--1)5-1 <br /> • � � BO6 4 CONTACT EMAIL: 9 _v'k �`} ! moi®a�^rin ` e � <br /> I BUILDING PERMIT APPLICATIONYIT 1� <br /> Existing Use of Building: Contract Price of Work:$ (4'V w -.— <br /> Proposed Use of Building: Heat Source: OGas ❑Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> lft 1V M6b`6rd(Atit GAPLL - <br /> ASSOCIATED BUILDING PERMIT#(if applicable): S 160(0--h02—• <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 /> A/C—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:1 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.l 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 La .27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> a"1 8 / 8 PERMIT# <br /> OA‘* 31 65-601 <br /> • , er/Authorize.Agent Signa Date (Revised 9/23/2016) <br />