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ligfPERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING I 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:"05 I it ((/f..,, j biz,ve PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ilDa�.A„r2 ti9,RA-2,g TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1.643 /L/i ,Il/i V.) D R We <br /> -'il.4Z-Z: 7`7-- CITY STATE / /' ZIP 9 Z 93 <br /> OWNER PHONE: / OWNER EMAIL: <br /> CONTRACTOR NAME: ff...,/k5 6r0/47 ?lih1Z <br /> CONTRACTOR ADDRESS: STREET ? 97i( 2 <br /> CITY VVV_OJ LSTATE 1,,,f 4 <br /> . ZIP gSQI <br /> 71 <br /> CONTRACTOR PHONE:749(, 9343 D,z72, CONTRACTOR EMAIL: :f'ff.„‘)/+ ? 4 –42th L,,t /t7 <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 24514-9'O,� Z7, <br /> —0 /`te0-11'7V�1 CONTACT EMAIL: 'd.6 ccra to G d7,'L . /bid,si <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ /4' ,41 <br /> Proposed Use of Building: Heat Source: CI Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Units: ❑Commercial ❑Industrial <br /> Type of Project: El New ❑Addition 0 Remodel ❑Repair ❑T •Sign : •rinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: RBILl i , 7 "4-to-1,0 ,d 76La17,1 . A ROA 26,li e. 4, 41- <br /> 51141:0701"07 Asitii ($6e) p .4...-.11/7-*P ;4e4a -eq., '' peee' Kge,,e4wegagre__ <br /> zi.0c ,g_-7-- <br /> 1- <br /> -r 16.”' Dong <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 /> 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 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.1 am the owner,or 1 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. RCW and 296.200A WAC. <br /> / City of Everett Official Use Only <br /> i �� °--�� PERMIT# rZdo//OwnerlAuthorize.,/,..(4.., <br /> S nature Date (Revised 9/23/2016) ( 1`�9 <br />