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� r PERMIT APPLICATION <br /> 'i BUILDINGII '' IECHANICAL/ 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ? 't`• c)L(.,C\t,t PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Lea eczsLL,t,,E St�/l.l TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET l?(4.4 ehca£. <br /> CITY LIJUZA.A. /� STATE n IAA. <br /> ZIP Q 2 <br /> , V <br /> OWNER PHONE: &(25' 173- S3p t, OWNER EMAIL: C�e(7J� Li3eA I-CCAS. /�Cril <br /> CONTRACTOR NAME: 3%,‘,F <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: 0 OWNER 0 CONTRACTOR BOTHER(Please Specify) HLAs SA AJC <br /> CONTACT NAME: CONTACT PHONE: Les. "(�.e�t4t( . �W <br /> ?i A LE UJA t't...t4.l S CONTACT EMAIL:?At�C,wlFt 1Is 1 64kAk <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 5kAA L ,p (,iL1 e ‘tM.A,)C� Contract Price of Work:$ <br /> Proposed Use of Building: 54. 'L Heat Source: EIGas ❑Electric ❑Other <br /> Building Type: flSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family #of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition '®Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 42' oc tXls.ILYA UAL— o tt2LACI.. V A) <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 BoilerLavatory(Wash Basin) Drinking Fountain <br /> _ <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/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 /> �' .,9 C. 6%0 '6.461 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> t' 12_ <br />