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PERMIT APPLICATION <br /> 4r4TrBUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> CITY 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 <br /> PROJECT SITE ADDRESS: 1142) RN T 40Ji0O J;-6 ,�'0'1� <br /> PROPERTY TAX#: -i t„/C <br /> LEGAL for new construction: Short Plat/subdivision <br /> Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:1"Prt(� 6--f -Pt-t\ --.N S TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Iq 2.41P <br /> elf\-0.- —, AV e. <br /> CITY �j j 1"L+ t t STATE A ZIP loo t <br /> OWNER PHONE:4Z5 411-Z. 0.3 'OWNER EMAIL: N/A- <br /> CONTRACTOR <br /> / -CONTRACTOR NAME: t AG-1L.. U c'J P -)-k No tG112- l`'1 V)ITA On.l k Nei <br /> CONTRACTOR ADDRESS: STREET lil DO1 n 1t,11 9)-T It D L i\t.- <br /> d p ` (� <br /> CITY IL\ Ci/�X t.%fib STATE W Ac- ZIP CI 0 0W7-- <br /> CONTRACTOR PHONE:42 ALI . L1.-1. 'CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED):Buk04.1 At 1 3' J 'CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):%•3 I <br /> PRIMARY CONTACT: 0 OWNER tiCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 42l� Skirt .34 i 1 (� <br /> yu� CONTACT EMAIL: 6. "'G <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: t bLdD-(2.4\1514c-L- Contract Price of Work:$ 1M <br /> — <br /> Proposed Use of BuJng: Heat Source: I OElectric <br /> ther <br /> Building Type: L�SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: DOerci <br /> y ❑Commercial ❑Industrial <br /> Type of Project: ONew DAddition ❑Rem odel ❑Repair CIT.'. ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <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 #of <br /> Fixtures Fixtures List List of Fixtures <br /> of Fixtures List of Fixtures #of <br /> Fixtures Fixtures <br /> NC-Air Handling Units Heat Pump Toilet <br /> Backflow Preventer(Inside Bldg) <br /> ( Forced Air Systems Unit Heater <br /> Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) <br /> Water Heater Refrigeration Shower Drinking <br /> Gas Fireplace Wood Stove Floor Drain <br /> g riFountain <br /> D <br /> Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher <br /> Clothes Dryer Hookups Other: RoofeDrains <br /> Clothes <br /> Range Hood Washer Medical Gas <br /> Exhaust Fan Water Heater Other: <br /> Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> (Chemical or Water ' 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 /> Building Ofci: . •:ing authorized under any circumstance.lam the owner,or l am authorized by the owner of this properly to perform the work for which application is made, <br /> and I co,•-,,'" : .Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 440( <br /> �//� PE I # <br /> / ./I�._.Ir � `L"1 — <br /> IS n- -uthorize'T�e Signatu I ` ` ` <br /> Date (Revised 9/2 I <br /> 3/2016) <br />