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PERMIT APPLICATIOf— <br /> , 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 I 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: ( 23 Qo(.. a I(-e`r' /we PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ." '"l U�a��i,,> TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 15 2-3 IAC 11 e•,,r 4`/e. <br /> CITY 6 ' STATE �Jlk ZIP 9i32-0( <br /> OWNER PHONE: (,0 2_ - Y51- 15 O c OWNER EMAIL: <br /> CONTRACTOR NAME: 7,..1-tArtioP. i-i v _ ( cc <br /> CONTRACTOR ADDRESS: STREET 10 2,7 aroPJ1 cy 14),/÷ <br /> p (� ? <br /> CITY Cv.t�'�, ' / STATE ,+i ZIP /g'✓ ( <br /> CONTRACTOR PHONE: 4 Z..s- 2-S 1 - j,j'7 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): /kAJ d `lh/aCITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5' 33 Lt <br /> PRIMARY CONTACT: DOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:: CONTACT PHONE: Lev Z - q32- ' /$^D g <br /> �V`44.3 CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ r521,9 <br /> , O� <br /> Proposed Use of Building: Heat Source: ❑Gas C lectric DOther <br /> Building Type: ❑SF etached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: DNew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> p a s i f e �n cj`t-A.��" y�r"-'- c��z 3 V L p�fi c. <br /> O t <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 Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> I 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 /> � 4111.1" �` PER #Itv" <br /> q <br /> Owner/Authorized Agent' gna - e 'at= (Revised 9/23/2016) <br />