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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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blueor BI"ack,=Ink'.Only'Please) 'PROJECT SITE,gINFORMATIONI ' 4' AT` ''AY <br /> PROJECT SITE ADDRESS: 1511 13rojd boa-LiA-1J4 PROPERTY TAX#: 0 L-1,523(6,3 00 qt c7 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT 1NFORMATIONT. <br /> OWNER NAME: 1<It tea' / J TENANT NAME(If Commercial): e&f l I h,S I Q c <br /> OWNER MAILING ADDRESS: STREET PO 6ae 5 221.° <br /> CITY (f-��� t ft STATE w ZIP 49 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: M,/A4-� �) ott1. (a' pante <br /> CONTRACTOR ADDRESS: "�b STREET 7�%i0�j � -w-j /�f S <br /> CITY MD wet- V ettlA,(,n, STATE ZIP 'SZ-T3 <br /> CONTRACTOR PHONE: 3U0 -'L4,a1' (3-)..S- CONTRACTOR EMAIL: efts.„ 1i.e(2 <br /> CONTRACTOR LICENSE#(REQUIRED): �y�� L g3Z3 a CITY OF EVERETT BUSINESS LICENSE#(RREQUIRED):5 7 3 lb <br /> PRIMARY CONTACT: 0 OWNER LCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: .j u 4.1 — 3 <br /> S .1[jf-an) GinA (A1- 4- CONTACT EMAIL: sir.Ai'1�C <br /> BU,ILDINGyPERMIT APPLICATION;, <br /> Existing Use of Building: Contract Price of Work:$ Z/ 20O. CO <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel ❑Repair DT.I. argign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Watt 511InCNA :it1u.rwm&Q <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 List of Fixtures #of 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 /> 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 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 /> ''11011111Z) 1 ) 8 PERMIT# �l' VO2 <br /> Owner/Authorized Agent Si ture Date . (Revised 9/23/2016) <br /> 1 � <br />