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"11111d--4 <br /> CITY OFPERMITEVERETT APPLIC <br /> PERMIT ATIOfSERVICESU <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <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 /> 4 PROJECT SITE ADDRESS: / '/6 kcZ 0 le .t s Cf' PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> WiThOWNER NAME: /7qjk / 4 C�v TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /6/ ., CNC, <br /> (kE`r ((J.-Cm /q <br /> CITY / }-Pts` V STATE Ci' ZIP���D C <br /> OWNER PHONE: "-A4.5--`- .S 6---6"0` OWNER EMAIL <br /> Os CONTRACTOR NAME: /1/)<'►er30 /5'/P e/ Cc '>' Ij'1A6V4,j(I v ` 1N-81 1 k—iQV) 1 mei, <br /> CONTRACTOR ADDRESS: STREET ;�ZDD_-? r c()4r>4. (L "' <br /> CITY • I�V (0./)f // STATE q ZIP �/,.9.6O r <br /> CONTRACTOR PHONE: /f. c-(A51'.'j �i(. CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): g fJ (/(-2 f'f1 l t )TY OF EVERETT BUSINESS 11!LICENSE�" <br /> #(REQUIRED)W;61-131i <br /> PRIMARY CONTACT: OWNER ID CONTRACTOR 0 OTHER(Please Specify) 3k (P02 2'l t W <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 1:145-000., 0 C1 <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> ,/DESCRIPTION OF WORK: <br /> `� J2 S`a'/(t(�o - ce, 4-i rC ?cZCe <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 /> 1 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 /> SPRINKLER I 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 circ stance.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 Cont actors Law 18.27 R// and 296.200A WAC. <br /> J City of Everett Official Use Only <br /> ��� PER <br /> fI4,- i i /rot i„Lif VIA tor' ()&--b(do <br /> Owner/Au horized Ag=nt Signature Date (Revised 9/23/2016) <br />