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PERMIT APPLICATION <br /> BUILDING/ MECHANICAL I 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: '71 I R.vc.1t.Q R. AVE . PROPERTY TAX#: 004683/34004-oo <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Grit,al(6 &JAM se (3E:E.$OA{ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET '?1 I 1 J C,I<,E Q. Ala <br /> CITY a-V E/j j` STATE 1A,ok, ZIP 7 220 1 <br /> OWNER PHONE: 4•2,S 2.58 •. q(,p q S OWNER EMAIL: <br /> CONTRACTOR NAME: I4,b,1J(Sy Co 5TRU G J o bJ Co. <br /> CONTRACTOR ADDRESS: STREET {��!±1 1 4. .Sc C,J• I A'/6 . S S . Sr* IO Z <br /> G <br /> CRY .0 MON Q S STATE LA.)R ZIP QS0 Z,o <br /> CONTRACTOR PHONE: 42..$" .- Ca'12,- 32.3 3 CONTRACTOR EMAIL: ,v o,'CC.(h rt 6.i con S'G_ C..OAl <br /> CONTRACTOR LICENSE#(REQUIRED): HAki (r(. 1 4„4.04. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):OS3144 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (425-) (�?Z--82.33 <br /> Ma�C <br /> CONTACT EMAIL: h1C1.1 2 Q ti 0.4,044 co s . CSM <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: -„ p42466 Contract Price of Work:$ TSO®. rw <br /> Proposed Use of Building: C ARA 4g Heat Source: OGas L lectric ['Other <br /> Building Type: BgFR-Detached ❑SFR Attached ['Duplex ❑Multi-Family-#of Units: ['Commercial CI Industrial <br /> Type of Project ['New ['Addition I1 emodel ['Repair• ❑T.I. ❑Sign ['Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ADA SNot+3LdL.`'tb <br /> E)C 1 ST7M3 cl AAA.CaG 64714400 111% <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 #°f 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 /> 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 /> I Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> (Chemical or Water I INo.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 /> c r . PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />