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CEDARPERMIT EVERETTSTREET,APPLICATION <br /> VICE982S <br /> BUILDING") LECHANICAL/ PLUMBING /SIGN / 01 <br /> SPRINKLER/ DEMOLITION <br /> CI <br /> ",-.—A <br /> 3200 TY <br /> OF <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: x$77 4A®Cce�y4'T/eve" PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION ,-- <br /> OWNER NAME: f' a,, ,o,„,/� �/ TENANT NAME(If Commercial):a 4" c,(,2_ ,, <br /> OWNER MAILING ADDRESS:� STREET '/?3 2, " (�� c)L) T/ / �j /J L� <br /> �j� ,6.0e4dtG/'`�/ e. cry STATE e�y"r-- ZIP <0 D< <br /> OWNER PHONE: �/� OWNER EMAIL: <br /> /"i'1/�(�l�W. i 7 <br /> CONTRACTOR NAME: / <br /> CONTRACTOR ADDRESS: STREET /2/5 �'Ai .1 6,/ ,42 L, <br /> CITY / �ie.,d4el�j STATE L'''4 / ZIP -fa 7 3 <br /> CONTRACTOR PHONE: ,Z06'^ y/ 3' 1 CONTRACTOR EMAIL: ,'47C���f,,p9j,,L,`,it.,— pr`Dc f.1 ,G.e)r.t <br /> CONTRACTOR LICENSE#(REQUIRED): Aec,Q2.940 3 CITY OF EVERETT BUSFNESS LICENSE#(REQUIRE. p D <br /> AC 1 <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) /g14e,,7L <br /> CONTACT NAME: Adei/ �rz.'6,- ,.Gem CONTACT PHONE: ' 7C-- 1��---- ? 7 <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 575 oa <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <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 /> r/�er",c::5 C/'.. 4-e...- e",...77/''-e./s0a .1 <br /> 7) <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 #°f 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 Sty, tractors Law 18 7 RCW and 296.200A WAC. <br /> [�1j City of Everett Official Use Only <br /> PER <br /> Owner/ uth.rizes Agent Signature DDaatte / (Revised 9/23/2016) L 02___ <br />