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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> • 0—Iiii14-fr 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: 1/9/y WiW b t Ej IA/74 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> • <br /> CONTACT INFORMATION <br /> OWNER NAME: Oct[,,e, J 6vi S 6 n TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2.Z to $ gr 7 XV- $ Iv <br /> cry E,,,V`e STATE \d.j./ ZIP m03 <br /> OWNER PHONE: Li ZS WV 2. 2.. (3 8 OWNER EMAIL: <br /> CONTRACTOR NAME: Pi?e. 'Tec )k_ f/v; ,ri/k 1e) ( , , <br /> CONTRACTOR ADDRESS: STREET S.5 Z 6 /y3 i $ f 5 Lv. <br /> CITY Elll��'lll C 0 M,,4 1 c STATE 4/4 ZIP MPa OZ( <br /> CONTRACTOR PHONE: 1125 Z 73 59 CONTRACTOR EMAIL: 1 ft 1r 4 d,{ i ) ,r 1(,7/ , c‘-7 <br /> CONTRACTOR LICENSE#(REQUIRED): l ---___ CITY OF EVERETT BUSINESS LICENSEA #(REQUIRED): <br /> PRIMARY CONTACT: F OWNER El CONTRACTOR 0 OTHER(Please Specify P%PF 7 D <br /> 1 li C I'7 <br /> CONTACT NAME: CONTACT PHONE: 97 S Z 7 3 ‘ 05 5 <br /> S�,M 01`,SQ I CONTACT EMAIL: Fi Q I rm I Q M4 71. C D'►7 <br /> B LDING PERMIT APPLICATION <br /> Existing Use of Building: i / Contract Price of Work:$ IDI 0 O 0 r <br /> Proposed Use of Building: Heat Source: DGas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ❑New DAddition 2fRemodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ep�, cdfv)r le-i‹ Hs v s t. <br /> t4(116 r2.,)C <br /> w �r &o-0 �d d ShD. <br /> ,la n t Avoir".)- I �vD <br /> ASSOCIATED BUILDING PERMIT#(if applicable): / Y <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 2 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 2 Bathtub Urinal <br /> Gas Piping Boiler .3 Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration / Shower Floor Drain <br /> Gas Fireplace Wood Stove f Kitchen Sink&Disposal Grease Trap _ <br /> Gas Range Ducting / Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: / Clothes Washer Medical Gas <br /> Range Hood Z Water Heater Other: <br /> Exhaust Fan ( Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water 1 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 /> IPERMIT# <br /> f:11"n( 1) %/-/ Mkl'r,�n "17 - A3 `---?1so3 - DI <br /> Owner/Authorized Agent Signatur• Date (Revised 9/23/2016) <br />