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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OLT 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 33 I t �lA\\9 'w' PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: CIVNNIZI AiteirW,NA TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 13333 d AV <br /> CITY 5e vArk e STATE kAAlrVt ZIP CAIVC3. <br /> � <br /> OWNER PHONE: 471 Cr OWNER EMAIL: <br /> CONTRACTOR NAME: 13' 16 e,s c LANA,.r <br /> CONTRACTOR ADDRESS: STREET PCOC1C1 C✓ -` <br /> CITY AAN,A, STATE U1 , ZIP vO(4" k <br /> CONTRACTOR PHONE: 36I.0" 2fy00" tkk CONTRACTOR EMAIL: clb „12.1 Q feiv,0:1 <br /> CONTRACTOR LICENSE#(REQUIRED6C.M6. g'j4 %3 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: AOWNER 0 CONTRACTOR 0 OTHER(Please Specify) Z1 <br /> CONTACT NAME: CONTACT PHONE: 3614Y i 2e0' gN <br /> I)4,deS CONTACT EMAIL: to, a� f� <br /> � ,� � <br /> "�� BUILDING PERMIT APPLICATION <br /> Existing Use of Building: '(Z QtCJ t Contract Price of Work:$ IOW <br /> Proposed Use of Building: 0„F► 014/A. Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ..[ 1tuplex ❑Multi-Family4 of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> h.60 �.. L 4- o s0k L s t� ,ks a".Q,, �-� , n. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn _Alteration )epair Type of Project: _New _Addn _Alteration _Repair <br /> #of °f List of Fixtures # List of Fixtures #°{ List of Fixtures #°f 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 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 I SUPPRESSION SYSTEM <br /> Chemical or Water 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 /> PERMIT# i(i ' l�D� <br /> 0 <br /> er/Authorize ge ignature Date (Revised 9/23/2016) <br />