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PERMIT APPLICATIOo <br /> "IPPak —itBUILDING/ MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> r /' 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 /> 14.. PROJECT SITE ADDRESS: 37'/q t deer _ (t)A/g2..o/ PROPERTY TAX#: <br /> LEGAL for new construction: Short/Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: CV-e, W 49- TENANT NAME(If Commercial): 5h to I C,IK 1 <br /> OWNER MAILING ADDRESS: STREET ((11 <br /> CITY STATE ZIP <br /> OWNER PHONE: •-616 `j5® — $+gt1 A OWNER EMAIL: cau p X I gg �/Qa,I'10 p , coYA <br /> CONTRACTOR NAME: , .9,0 (9/,1 ticA <br /> CONTRACTOR ADDRESS: STREET c <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> p. CONTRACTOR LICENSE#(REQUIRED): EX.01) 90‘14_.-rU 9oL, 4ITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> �t PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) n <br /> CONTACT NAME: CONTACT PHONE: .,p 6 06- 673"d <br /> 4 CONTACT EMAIL: 'ti <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 4Tontract Price of Work:$ O 0 <br /> Proposed Use of Building: Heat Source: OGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. DSign ❑Sprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 'max 0-1- Wa.9-- 1A ,il, t. ‘-‘97 kARM CIO vV V—C15(-to l <br /> vehr, 6-1Y1 YR <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 #°f 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 /> 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.*1 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 /> 217 /200 <br /> / PERMIT#411106 <br /> � Y--co2 <br /> Owner/Authori --Agent 1r•nature Date (Revised 9/23/2016) <br />