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PERMIT APPLICATEON <br /> BUILDING I MECHANICAL I PLUMBING / SIGN /SPRINKLER/ DEMOLITION <br /> IgnaCITY 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 p <br /> PROJECT SITE ADDRESS: 8118 8eV e r-t�t '3 I.A.20 5V-e I tE ,_PROPERTY TAX#:0p 3c13 9OO So 22 O O <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> 4 OWNER NAME: :re cfce V (G.P J1 a 1 11 S TENANT NAME(If Cipmmercial): <br /> P 0OWNER MAILING ADDRESS: / STREET + JJj L 2C 2/gg 7 <br /> cm( 5vel-(.,.,,t( STATE /A,A ZIP 9 g21 <br /> OWNER PHONE: a 0 6v'S/ 0 ^ ((Fr�,� OWNER EMAIL: G{at`ill /?OSS M e 9 ivi ( t e't'Ai <br /> I" <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: 1 <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION / <br /> Existing Use of Building: Contract Price of Work:$r 1� ©00 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached El Duplex DMulti-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: El New ❑Addition El Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ElDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> .,z/61*(/ ,lei ,.6,7 7146 //1 My 1?AcA< yet- d <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New _ Addn __Alteration _Repair Type of Project: I New _Addn _Alteration _Repair <br /> #of List of Fixtures °f List of Fixtures #of List of Fixtures #°f 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/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 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 /> -7/0 7/�8 li PERI4 T�v(rVil— ®�� <br /> O #'. <br /> d A ent Si nature Date Revise�d9/23/2016 <br /> Of l <br />