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4err 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 /> (blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �I �24 (,(% PROPERTY TAX#:0043 g p,3�36ogQO <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 6 /s JOrt/ec �7 p_ TENANT NAME(If Commercial): c 7 Fvt 2Aie J 5 . <br /> OWNER MAILING ADDRESS: STREET /gya. / gc) -IE[_ (,&014.,/ /)6 5TE 1 Q,' <br /> cIT( 23677-j-C.LL STATE L1JA- ZIP ! V. !/ <br /> OWNER PHONE: to-a `7i--a ffl5 OWNER EMAIL: <br /> CONTRACTOR NAME Y d-�/T e PLurv)-t,31,.�(' d-lE4--7-ku <br /> CONTRACTOR ADDRESS: STREET /( 4f� is A-v-e_ (.(.) . <br /> CITY LY/4 AJ(A)COD STATE !/(JA- ZIP R BO 3 <br /> CONTRACTOR PHONE: y25_11 —Cj c/ f CONTRACTOR EMAIL: gre-)ti4A) o,e4-y 4M/Q nJ/7-6, Ai.,--- <br /> CONTRACTOR <br /> i. jCONTRACTOR LICENSE#(REQUIRED):pfry,,,x-pi-fcrt-o-iieg CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):oiq 7q/ <br /> PRIMARY CONTACT: 0 OWNER XCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L.f Z6"—mac—/ /(ocJ <br /> rr(A) e L( CONTACT EMAIL: g 0,,.,Q p eli,yAA)DN t-re• <br /> BUILDING PERMIT APPLICATION <br /> -Kisting Use of Building: Contract Price of Work: $ 3/ g-(06,.'7�L <br /> 4 <br /> I roposed Use of Building: -"iilklQ4"►c ,-GSntr Or-. 0 Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: gcommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: pO l aurvit5PV6 7 f S/A)K5/ . /a/Ler) 4WrvD I JISHwAH <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 bAlteration 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 f 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 I Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Z. 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 /> avrrent 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 /> gilding 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 /> le ex.,,,A., 1 y r PERV r ,zzO lXJ <br /> IIIIIlifil <br /> 0 ' tho/fed Agent Signature / Date (Revised 9/23/2016) <br />