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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> ;-1 ii14/477 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: / /C -1 riliVit. <4.- PROPERTY TAX#: <br /> 6. <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Ll 5eaf y LgY l/C L TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: / STREET c21 t S' (t. e-7'f.- 54 <br /> CITY STATEAK ZIP `y(6 3 <br /> q7,�' S`77-ai(Z�' y c� nt ( <br /> OWNER PHONE: OWNER EMAIL: (' Llt�t ! (�SI-�LIr .+.).,,,,tf . <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET &(LES At, eV(' c4- //'� <br /> CITY Gx ,_ STATE-(/V4 ZIP '',e(C)7 <br /> CONTRACTOR PHONE: Kac- 577-gait CONTRACTOR EMAIL: — fi Cy/vilef- 'Akc., <br /> CONTRACTOR LICENSE#(RRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: p OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 2��� S CONTACT PHONE: (,j �S- 5-7 7 --'(2.r <br /> CONTACT EMAIL: ,{�lyGctt- mite a4/D�,,Ne J.-- <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ q/ u <br /> Proposed Use of Building: Heat Source: ❑Gas ,�Elsstric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New ❑Addition emodel ❑Repair CIT.!. DSign ❑Sprinkler ❑Demolitions❑Change of Use <br /> DESCRIPTION OF WORK: ,4/ v7,ba/2-E� f/,ii r-!` f.et)r� `, 30vc /2w, �lc,/C'4✓ <br /> (,)1.b1D1 &i ((4C. i,k 1 02 rn -he--1, r-4-..s. (dk I L 1 <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 /> 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 \,r,..,ieffi tion j Shower Floor Drain <br /> Gas Fireplace Wood Stove / Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting 1 Dishwasher Roof Drains <br /> 1 Clothes Dryer Hookups Other: / Clothes Washer Medical Gas <br /> Range Hood a Other: <br /> Exhaust Fan 2 Sink(Service/Bar/Mop/etc.) Other: <br /> S.-- <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I No.of Heads !h <br /> ACKNOWLEDGEMENT:1 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.l 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 /> _ CityZmArgior--01'e ,,, ff(2 (' . e )1 �4of Everett Official Use Only <br /> PER1yllJ#rr V — COI <br /> 1 <br /> f,wner utr- ,d Agent igna eillip Date (Revised 9/23/2016) <br />