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eLk1 Ip G� 7 w ill pt C!< u lil i <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> /104// 1111P:::A CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) arra <br /> SITE INFORMATION <br /> PROJECT SITE ADDRESS: 5-(03 114'9 k a*-( "01 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ep-'.veeci' Q / TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5(63( kik 6+-Ac d -(,i <br /> /- CITY W' _g.tv STATE WA ZIP q 8 203 <br /> OWNER PHONE: 2„0(0 € 10kil Z. OWNER EMAIL: <br /> CONTRACTOR NAME: O rl t�errit � t <br /> CONTRACTOR ADDRESS: STREET <br /> t "{1 '� B SO< 4W(/j., <br /> CITY'RAJ',Rexi v - STATE 1 ZIP C^'rg 20 1 <br /> CONTRACTOR PHONE: t 1-125-25e1 0550 CONTRACTOR EMAIL: oLbk 1e 0 C,,,,,. ,eccr1( .co ry. <br /> CONTRACTOR LICENSE#(REQUIRED):Gear ft.l J' 11 d(I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): I(,p 09'8 <br /> PRIMARY CONTACT: 0 OWNER ?ONTRACTOR 0 OTHER(Please Specify) <br /> i,,6 <br /> CONTACTV ��. <br /> �NN�AME: CONTACT PHONE: .� riot 0 <br /> em," .c ► ('-` :e b(Q,r CONTACT EMAIL: c b(e((Cryt, -{ I . ten <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ l t ,000 <br /> Proposed Use of Building: Heat Source: ❑Gas pLlectric ❑Other <br /> Building Type: PR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition El Remodel ❑Repair DTA. CI Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> .mi - c-. <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 #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 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> 2 City of Everett Official Use Only <br /> ZegA‘7 '(� 3 - , PERMIT fl \O Ov \ <br /> Owner/Authorized Age t Signature Date (Revised /23/2016) <br />