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PERMIT APPLICATION. <br /> ,� BUILDING /MECHANICAL I PLUMBING/SIGN /SPRINKLER!DEMOLITION <br /> .f 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: (0 bi 5 EEit(el ivi aW ( lsrEI-J <br /> PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:.?Cl5' .1 (,Of. TENANT NAME(If Commercial):,4 4L (4/0 <br /> OWNER MAILING ADDRESS: STREET 6p 7 _Sr EC,/ rti,,4,�' CAA*/ <br /> E e .e ili-- CITY rA1 STATE z 9a°ji^ <br /> OWNER PHONE: 7r--- .7e7/is--7 OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> ett1 4)-Xneyi ra.tir\ Ft riP_ Pyi4-�C:i on <br /> CONTRACTOR ADDRESS: STREET 'P.O. (6 opt t c-\"3 <br /> t CITY EV e �-e VI J STATE ' zip ,( cg. <br /> CONTRACTOR PHONE:(`-f Z5-")*2&..2) - '3'S',£-j CONTRACTOR EMAIL: Cki I conurm.gy)._rf r,.e(c q h I.Coal <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS UCENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER TRACTOR 0 OTHER(Please Specify) <br /> CONTACT/ NAME: CONTACT PHONE: (��� -7..-6'1' 'j-f <br /> / eAAy �/ 4/1 CONTACT EMAIL: f Pt/ _if: ,A,Z -LO/} <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: l- 4v/,4.i/ Contract Price of Work:$ \h IOb. _ <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 CIT.!. ❑Sign ['Sprinkler ['Demolition ['Change of Use <br /> DESCRIPTION O F ORK: <br /> /*' ,� -Pi a - 1-q pe,I4Docl <br /> ASSOCIATED BUILDING PERMIT#(if applicable): la,(,p(l 0v2 44_ -- b2.`Z- <br /> M 1�-0�- <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 <br /> Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Femur s List of 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 SUPPRE-.-, 6 N IM <br /> Chemical or Water I 1--) .of Heads <br /> ACKNOWLEDGEMENT:I have reviewed thi . on 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,lam the owner,or/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 Onfy <br /> �� <br /> PERM \,/1 \ 0 0 I <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />