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efrPPERMIT APPLICATION <br /> BUILDING I 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: FI)--7 (:)./.Y /�' �'�(� PROPERTY TAX# <br /> LEGAL for new construction: Short Plat/subdivision ` Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: /74)5A I/44(-7 TENANT NAM (If Commercial): <br /> OWNER MAILING ADDRESS: sTRLET5Y) ( <- 0 L. . ?,+ a I v <br /> CITY =. 7 1 STATE / ZIP 2O <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: eti5 - uA O� ") (de,,k° <br /> CONTRACTOR ADDRESS: STREET e 3(l'7 -7-w ; la <br /> y� <br /> 1 <br /> CITY [1„,..,, 10„ 5 STATE (r1, ,qt JZIP 9,22 <br /> CONTRACTOR PHONE: Z/ 5-2.- e-1 33,-5S 6, (CONTRACTOREMAIL: idc.(^,,g�3oc.✓IacGt3Lvo„Al°x� ;7,ea--� <br /> CONTRACTOR LICENSE#(REQUIRED):eV q,�(/1 6 ICITY OF EVERETT_ BUSINESS LICENSE#(REQUIRED): �_s- i <br /> PRIMARY CONTACT: 0 OWNER q.CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: �/ l CONTACT PHONE: 5-,..-3 3 6 �j?Q <br /> !� "e� ( GPr/V�t`e CONTACT EMAIL;,/Jt/ co0T-SCIA eibaS SOV`'�S OVsu, I (:c1o^—` <br /> 1' �J <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$__/'g©'. ©f° <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition DRemodel DRepair all. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Arm 3/y k 9 :4 <br /> 4/0 VA U( hoc'$ -Tp(„--e.e. `'� ' 2 \e 4,`e�'- 4 b <br /> / i% _ ,/I(/Q e-e-- -��s`2✓+----- <br /> AS S 0 C IAT ED <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 #°f List of Fixtures #°f 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 /> / Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> fGas 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.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 /> PERM( <br /> — r Ig ill Q)Oi— b(c? I <br /> Ow er/ uthorized Agent igna ure Date (Revised 9/23/20110 <br />