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PERMIT APPLICATIO <br /> BUILDIN!HVIIECHANICAL/ PLUMBING /SIGN INKLER/ S EMO LITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> (!'liiii$477 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: IC I'4" grad L✓c0 Ave- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> , <br /> OWNER NAME: (1\4,:gg Jp"Le S TENANT NAME(If Commercial): eil!`r s 7:17;2"/7:17;2"/Le� c�5 <br /> OWNER MAILING ADDRESS: STREET (ap,41.-4- 63.04-64,.(( La / ke, (D : <br /> CITY ✓0 0. 11 ' STATE (d A ZIP ISO II <br /> OWNER PHONE: Z 6 6 % f/ `lel 5 OWNER EMAIL: Circ ,, S ilt2 , M Toil_ e6fet le,Ilrn,c <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT�N`A�ME: CONTACT PHONE: <br /> /� 6 g cI 1 IM c <br /> e/ N �' / _Sep c.�,5 CONTACT EMAIL:a r,,`jes 15 " .W.) r ti(i2:51-013-e fuF/t <br /> BUILDING PERMIT APPLICATION G <br /> Existing Use of Building: Contract Price of Work:$ 5OO.1'2- <br /> Proposed Use of Building: • Heat Source: ❑Gas 0 Electric DOther <br /> Building Type: DSFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: DCommercial 0 Industrial <br /> Type of Project: ❑New DAddition DRemodel DRepair DTI. ❑Sign ❑Sprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 4,^-t p Qv-. 4 cGl .c.,1 Nit, <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 #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—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 I 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:•fore b-' .i 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 compl ,•h the ' . -Contractors Law 18.27 RCW and 296.200A WAC. <br /> / r City of Everett Official Use Only <br /> PERMI # <br /> 1/ef j r. b 1W -o05 <br /> 0 '•r/Authorized Agent Si. . ure Date (Revised 9/23/2016) 4 <br />