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PERMIT APPLICATIOt— <br /> BUILDING I MECHANICAL I PLUMBING /SIGN /SPRINKLER I DEMOLITION <br /> 047.7. <br /> 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Plea- PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ,(/4 ,At > F—:(,-/e141PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/ bd' sion Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: OL t l ' d• `aticA/Q f,(/ / TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRES /STREET �� IWItA etAzie9r.c" <br /> CITY .5es]4./6 STATE ZIP 914 • <br /> OWNER PHONE: "46 3 ?Q 7``' �'"q�,�/s"" OWNER EMAIL:.& / ©/aiokc )/gc4 C 4,,..., <br /> CONTRACTOR NAME: 0,,,,,...,-, <br /> CONTRACTOR ADDRESS: STREET ! I ;4424& r <br /> CITY (,- ' • g. STATE 1� ZIP 79v/2-...2._CONTRACTOR PHONE: 6 370 ,tfLf� G.' <br /> - CONTRACTOR EMAIL: ,Se ._ tiu/OA, M,‘'n • !e,,,,..._ <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: DOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: +g i �10�Q�� CONTACT CONTACT EMAIL:: �k 3 7 �l <br /> (I �'e1 ,� rl c.I/�7/�'GL J MS/l rd,v • <br /> BUILDING PERMIT APPLICATION I <br /> Existing Use of Building: Contract Price of Work:$ {O 0 <br /> Proposed Use of Building: Heat Source: ❑Gas Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached 6uplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑ epair DTA. ❑Sin ❑Sprinkler ❑Demolition ❑ hange of Use , <br /> DESCRIPTION OF WORK: r ��e, pi") c4/4"----- n.fil �,,-- ��� e ��� <br /> h <br /> W d1^ ,�- 14 ° e2n 4i'- <br /> //ev <br /> (.4&:- po te..e_or.-7.0 <br /> ASSOCIATED BU I T#(if apa le: / . <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 i Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I 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 /> Ar <br /> , '� PERMIT 310 At ' 4----.Owner/Au' orized Agent Signature / to (Revised 9/23/2016) <br />