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PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN/SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OLT 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 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: 799 ifx-Rs6- P7 A-147-719 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: :.(:04/I9(/n j'fi7C h j( 1, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET// 7/Oi Ail/CQc-s rte/ t,^A C�/z <br /> CITY �� STATE J . ZIP /d 3 <br /> • <br /> /14-5- .7 ?j <br /> OWNER PHONE: — '��- 21 OWNER EMAIL: Af ' Dieg ,,yty,e€&4'm+1� vs f*_6- <br /> CONTRACTOR NAME: p?..P.--f6-e-- l0y/� /�j� rte'CONTRACTOR ADDRESSREET 7�� //JF/ // y <br /> CITY f Ta 4(4//Li STATE iiitt ZIP °Z.V,,I :r <br /> CONTRACTOR PHONE: "2.0 - 174 - e Tvg CONTRACTOR EMAIL: -puO1J c- " £l/U CSC 'pu-t <br /> CONTRACTOR LICENSE#(REQUIRED): i/o-re---11f4 oto{ CITY OF EVERETT BUSINESS LICENSE#(REQUI^ D)610 `f <br /> PRIMARY CONTACT: 0 OWNER C&CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: c2._ - /et- ye? <br /> J [)JJ C(-VN CONTACT EMAIL: bitop(s La hc)O1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ b b1 P-76- ere) <br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 6X*ffay- o/L t tP ii- 7m(( e roey3 L7 <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 #°f 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 I SUPPRESSION SYSTEM <br /> Chemical or Water 1 No.of Heads <br /> ACKNOWLEDGEMENT:/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 Stat ctors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMT <br /> 97/? 77 toct - ci4 L <br /> Owner/Authori Agent Signature Date (Revised 9/23/2016) <br /> 1 <br />