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PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) ' PROJECT_SITE.INFORMATION , <br /> PROJECT SITE ADDRESS: 51 1 U O • IA-Vie.() DI/1 a.C/ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: A(t�t . F1 c .A.". 4- PSS TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREETS K Sr(D w• VI pc.1 br(10-A--- <br /> CITY <br /> LiCITY STATE ZIP 1 g 2-03 <br /> OWNER PHONE: 6,06) /�O " O,L ( OWNER EMAIL: <br /> CONTRACTOR NAME: t ie.-C-1 k.l"-C,I1 <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> �/ j� , <br /> Lg <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR OTHER(Please Specify) De--4(1 o'er" <br /> CONTACT NAME: p CONTACT PHONE: C2LO <br /> O N Yt CONTACT EMAIL: <br /> BUILDING,i PERMITA,PPLICATION ` <br /> Existing Use of Building: ( FIL- Contract Price of Work:$ 1O O 4 O'' <br /> Proposed Use of Building: A'14r.. 1.4— 47 l_k.t Heat Source: IliiGas ❑Electric ❑Other <br /> Building Type: EQ/FR-Detached ❑SFR-attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition �U'Aemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 0(/ l ch c� / t(43 , A n �_(Ia i <br /> '„ t�-P•�_ 1 �I o ✓( x115 ��b ‹ ✓` I <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 /> SPRINKLERI 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# <br /> It0 l80t0-601 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> -(_.12_._._ <br />