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PERMIT APPLICATION <br /> � � BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> �► <br /> 1.11/0.4.%/ ---- <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: 1120t Z., to I� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: b<6.011 &`pmii\ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS‘) STREET it )J S£ <br /> cm, ifee STATE WA ZIP 9gZ08' <br /> OWNER PHONE: go - log- 31 OWNER EMAIL: <br /> CONTRACTOR NAME; n t0f 0,(` A G2 <br /> CONTRACTOR ADDRESS: STREET as 7 rtma,k) <br /> CIN ev"r V STATE W P ZIP qs V <br /> CONTRACTOR PHONE: g , 'g•s-q - _t 6 I CONTRACTOR EMAIL: to .COCO614 I'•CO t^'\ <br /> CONTRACTOR LICENSE#(REQUIRED): Q N I 1.10.1.01CCITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER it CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: n CONTACT PHONE: 3 o . G- 1 .-Yq00 a Pl, <br /> (�� <br /> Q1/t'n 111t Yf lit CONTACT EMAIL: V..tul/l •dvS�o jvgtt• Com" <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas El Electric 130ther 1C406GQ <br /> Building Type: ❑SFR-Detached ❑SFR-Attached El Duplex ❑Multi-Family-#of Units: CI Commercial [Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: L <br /> IAS CYf IVw Wt/Oa 5 (.E -e SI-44n)) <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 _Adds 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 /> 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 /> 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/am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ^ <br /> Th *"' (Vt?/ I PERM T#°1) �1 \e 0 <br /> - OL( �— <br />