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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> /11111410 — <br /> . - CITY OF EVERETT PERMIT SERVICES <br /> vilic <br /> 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: 2_,24 0 V j r j�'1�� &' PROPERTY TAX#: 1-1 PROPERTY 5_4-11-©Z,-OD <br /> LEGAL for new construction: Short Plat/subdivision JJ CQD Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: I'`1 d"R--E' 01-4;2— TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 22.b \/i Itj1�((,L,A <br /> CITY ektere"�"-' ((,�J STATE ry A zip � <br /> OWNER PHONE: 4Z� 25Z Lt�k1 OWNER EMAIL: ( j c /1 Z (-C Z LI Z l( i1- /1/47('-'filo",l L, <br /> CONTRACTOR NAME: 0 )/V h r <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: IN,OWNER ❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (.,i '7%. 1/41- '- 6 et 1 /3 <br /> C a . CONTACT EMAIL: f ' C S 7 8 710,/r <br /> BUILDING PERMIT APPLICATION n /� <br /> Existing Use of Building: 4`yC.(fIAa A. i'C/i✓7-ecl f- 0 Contract Price of Work:$ 3 2--OC J <br /> Proposed Use of Building: L.i V /AY t/ l" i- Heat Source: ❑Gas Ga'Electric ❑Other <br /> Building Type: D8FR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition 11Change of Use <br /> DESCRIPTION OF WORK: r <br /> r Ct-e- ti I <br /> t S 4--c n ,)- " - i'c,,-(-74- 1 n 'f- Co L i V i h Y <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 1 •-... Toilet Backflow Preventer(Inside Bldg) <br /> l Forced Air Systems Unit Heater I — Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> 1 ."—. Water Heater RefrigerationShower Floor Drain <br /> Gas Fireplace Wood Stove / -- Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> I Clothes Dryer Hookups Other: ) ----- Clothes Washer Medical Gas <br /> 1 Range Hood 101.00 Water Heater Other: <br /> lb. 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.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 /> PE IT# <br /> /) (. ,/ia/1e ) \ O2 — Ob -� <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />