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PERMIT APPLICATION <br /> 4-77BUILDING / MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (A)425-257-8810 I FAX 425-257-8857 I(E)everelteps tgeverottwa,gov I www.everettwa.govfpormits <br /> (Blue or Black Ink Only Please) PROJECT SITE'fNFORMA`rION '' <br /> PROJECT SITE ADDRESS: 1L J 2 , (� 11 /a , <br /> !J<.1r jG f PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision <br /> Lot No (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Ad ' ") V I 'tO <br /> '"'` 9 TENANT NAME(If Commercial): <br /> OWNER MAILING ADC38?SS: STREET 1°40(0 -I-c ) .r <br /> STATE ZIP <br /> OWNER PHONE: J t <br /> —q 123 OWNER EMAIL: <br /> CONTRACTOR NAME: , s <br /> CONTRACTOR ADDRESS: STREET 14' Tor Ct.{ 0 <br /> ciTY <br /> STA IE A- ZIP * ♦ 20 , <br /> CONTRACTOR PHONE: Lr So CONTRACTOR EMAIL , , e v <br /> _ ` $ A4 ! # rks .GCS <br /> CONTRACTOR-t,#DENSE#¢RLFOtJ9?�EI�j: <br /> i " 0C-15R(4..—CITY-OF EVERI'TTBUSINESS LICENSE tl(}iEOTJIRED <br /> PRIMARY ONTACT: ❑OWNER CONTRACTOR ❑ THE (Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: 1,,, 26 28(3 C). J <br /> CONTACT EMAIL: ,dja Lb e Cern I/ ad-1 <br /> --� 14 C.0111 <br /> BUILDING PERMIT APPLICATION" <br /> Existing Use of Building: <br /> DO .--� <br /> Contract Price of Work:$ <br /> Proposed Use of Buildinc: <br /> Heat Source: Xas DElectric ❑Ocher <br /> Building Type: ?SFR-Detached OSFR-Attached ❑Duplex ❑Multi-Fan:!•-#of Units' 0 Commercial <br /> Type of Project ❑ lion ❑ n <br /> New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑DemolitChae of Useustrlal <br /> DESCRIPTION OF WORK: j�, fI,t <br /> acts -F),,,,ace._ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION <br /> Type of Project: New Addn Alteration `Repair <br /> #of Type of Project: New Addn _Alteration Repair <br /> Lit,o..fFixtures .._..._.... #of #of <br /> __Fixtures'__— Fixtures Listof Fixtures _ __ List-of Fixtures -_—__. #of i <br /> Fixtures —__ List ofFlxtures <br /> AJC Air HandlingUnits Fixtures <br /> Heat Pumra Toilet <br /> Forced Air Systems Unit Heater Backflow Preventer(Inside Bldg <br /> ) <br /> Gas Piping Bathtub Urinal <br /> Water Heater Boiler 'Lavatory(Wash Basin) <br /> Refrigeration Drinking Fountain <br /> Gas Fireplace Shower Floor Drain <br /> Wood Stove Kitchen Sink&Disposal <br /> s Ductin p Grease Trap <br /> Gas Ren <br /> Other: Clothes <br /> Roof Drains <br /> Clothes Dryer Hookups <br /> Rante Hood <br /> Washer Medical Gas <br /> Exhaust Fan Water Heater Other: <br /> Sink Service/Bar/Mop/etc. Other; <br /> SPRINKLER'°/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKIVOWLEUGEMENT,-I have reviewed this application and confirm Nre information contained harem is true and correct.Work done pursuant to this <br /> current federal,state,and local law The waffling of a permit only authorizes approved work and no deviations therefrom,Oavrations must first be authorized In wrrttn foe <br /> funding Official before being authorized under any circumstance,t em the awnar,or!em authorized by the owner of this property forma must tt:alie ITttr <br /> acrd t comply with the Stator Contractors Law 18.27 ROWenrd 229G.�WAC. 9 rn the <br /> P p y to perform the work for which apeiicaticarr a raraolea, <br /> Oily of Everett Official Use Only <br /> 1 o �.ia 1 PER T S <br /> Ow,er/Au i » d Age Signature.0 ; I D \�0�-- <br /> g Signature Date <br /> (Revised 9/23/2016) <br />