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PERMIT APPLICATION. <br /> A°111j---A BUILDING/MECHANICAL/ PLUMBING /SIGN I SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink.Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3 C Q 5 l i vt e St PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): neLla 1-161-e L lox maiviol+ <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 7"--,' Cco/G p/bq 77 vvi'S ii4ec%Gvi/ca t P u$ <br /> CONTRACTOR ADDRESS: STREET&(O 2 W /r ore pr 4(.L) <br /> CITY /rn boy- STATE /...(j.4- ZIP <br /> CONTRACTOR PHONE: 2 53- 2 2 y - 906 S CONTRACTOR EMAIL:-it:J.4srdec Ince)ra L i L•i ,Caw) <br /> CONTRACTOR LICENSE#(REQUIRED): T t WI S yvnM to 90 7 C3 CITY OF EVERETT BUSINESS LICENSE#(REQUIRE r : <br /> PRIMARY CONTACT: ❑OWNER I,XCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: T �a� CONTACT PHONE: 2 S 3—z 2 -(--`'O S <br /> CONTACT EMAIL: f-1 wtsec L <br /> IMS ti, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: j Ice e L Contract Price of Work: 1,700(S)C.) <br /> Proposed Use of Building: /- L, Heat Source: CI Gas 11Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: iltCommercial ❑Industrial <br /> Type of Project: CI New OAddition ❑Remodel ❑Repair DTA. ❑Sign ❑Sprinkler ❑Demolition ['Change of Use <br /> DESCRIPTION OF WORK: <br /> _L Lzs- ll pre_fc, b 6,4.1 cc c ( loox aKa( re <br /> S y S i-ewt <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 /> Fixtures List of Fixtures Fixtures List of Fixtures Figur s List of Fixtures Fixtu►es List of 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 /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting �Q 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 /> PERMIT# ^ , ( O r <br /> 12—t 8—,20 1 7 �;I� \` `�1-1` NYC, t ( <br /> O • •uthorized Agent Signature Date (Revised 9/23/2016) <br /> a--\\ <br />