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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> /1,04%°,0 /-6;----g CITY OF EVERETT PERMIT SERVICES <br /> sold .Wc 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps©everettwa.gov� www.everettvra.gov/permits <br /> or Black Ink OnIPlease) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1121 V iie pinW PROPERTY TAX#�(�:A‘ re _ Li(----) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. <br /> (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: !Hill 1ile ? (lel Blit I oh TENANT NAME(If Commercial): i '. <br /> OWNER MAILING ADDRESS: SIRE <br /> 12 o a aw U y ►r eve. <br /> CITY -V-w‘ 4 i STATEV`� , ZIP I W 1 <br /> OWNER PHONE: / . 1Z, J 11 OWNER EMAIL:olfl ' red W\ i W . or <br /> n y <br /> CONTRACTOR NAME: ��� ���#7 (`�y�C�, `f�'� <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: 1r /i 4.21111 <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BU NESS UCENSE#(REQUIRED): <br /> PRIMARY CONTACT: D OWNER 0 CONTRACTOR OTHER(Please Specify) ?N1� 1 - <br /> CONTACT <br /> NAME:/CCONTACT PHONE: • S( • ,t�9 <br /> D�r'//� 0\14M CONTACT EMAIL:D o t S 1'�V V fi n c ` . (, 'WI <br /> BUILDING PERMIT APPLICATION 4,006:0 <br /> 1 rr ��ll <br /> Existing Use of Building: �vI / Contract Price of Work:$ 4ri 6•d V <br /> Proposed Use of Building: 1 V 14.-- Heat Source: ❑Gas ❑Electric DOther n 1 4 <br /> Building Type: OSlR-Detached DSFR Attached 0Duplex DMulti-Family-#of Units: ommercial ' Dindustrial <br /> Type of Project: ONew OAddition emodel DReeair CIT.I. CIS' ❑Sprinkler ODemoli'on OChange of Use <br /> DESCRIPTION OF WORK: �n�n `^ t ( \ e, r r\ boy <br /> e xct k-ir <br /> \'�I` } ' <br /> i V�(/ 11 V r� Y t y 'G �/ �/ <br /> r-1-1-M \vcfr //in 01 NP USM ILidASSOCIATEDBUILDING PERMIT#(if apicable). <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: _New Addn Alteration Repair <br /> List of Fixtures List of Fixtures Fixtof ures res List of Fixtures Fixtures List of Fixtures <br /> Fixtures Fixtures 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 INo.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 /> Build •Official before being authorized under any circumstance.I am the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> a /A <br /> ••••�,, with the State•• ,:p• w 18.27 RCW and 296.200A WAC. <br /> Cityoof EverettnOfficial Use Only <br /> I L . <br /> ' PE � v\v 022 <br /> i •`zed Agen ature T.'=to (Revise 9/23/2016) <br />