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*Iren. PERMIT APPLICATION <br /> BUILDING/MECHANICAL I 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 1(E)everetteps©everettwa.gov( www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1 g j 7 V(c0:140i S (PROPERTY TAX#: d 04 (f' t9oo - )i, <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: V ; e.ti j),€ L 1 .e.- TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: sTREeT 01 (p A o 4-p ." St6 LA) <br /> ), Q <br /> /.. CITY g yer-41- STATE W .k, ZIP 9 a c a <br /> OWNER PHONE: ;4015% A l "+�a+ e 8 OWNER EMAIL: r <br /> CONTRACTOR NAME: kit,tlt t s.✓dl CTfG� ''-•,�J e.d (fV t e+61 ..r1/1.C <br /> CONTRACTOR ADDRESS: (J STREET p Q -475-8 - et,`{/3 1$r g•Ave A/ E. <br /> CITY L.&/(e 5t V�eeiS STATE Oa. ZIP 9etAs-2. <br /> CONTRACTOR PHONE: 'I r 5. -33 5- 4,207 CONTRACTOR EMAIL: ri.. temti t/1 `a t:frig Q iva-�t t 1+t e„ a ark <br /> CONTRACTOR.LICENSE#(REQUIRED): t (614--rgit.i l AR e A CITY OF EVERE BUSINESS LICENSE#(REQUIRED):3 9&p tie" <br /> PRIMARY CONTACT: ❑OWNER )(CONTRACTOR EI OTHER(Please Specify) <br /> CONTACT NAME: . CONTACT PHONE: - sto O 7. <br /> CONTACT EMAIL: .j ea>t k e_ rl' pi l De 114 �e +rt ,Lr a7+( <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 5 rx. Contract Price of Work:$ ,A$ O 0 <br /> Proposed Use of Building: Heat Source; ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: DCommerciai ❑industrial <br /> Type of Project: ❑New ['Addition DRemmodel ❑Repair DT.I. ❑Sign, ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 14„5 Pip 47 4 6k-- . e 11- <br /> s <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 AddnAlteration _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 /> Cp 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/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.lam 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 otEverett Official Use Only <br /> ' cLuLt.4.0/ <br /> PERMIT# <br /> Owne uthorized Agent Signature Date (Revised 9/23/2016) <br /> 1 <br />