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PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> � , CITY OF EVERETT PERMIT SERVICES <br /> Niiiiiii 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425- - 7 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PR JECT ITE INFORMATION <br /> PROJECT SITE ADDRESS:gill(' 7 N`.G% 57 PROPERTY TAX#:Oi 01 -180000 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ill% iJ OLbeir TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET qq(0 Jt... 13c <br /> CIN ? +4-) Vv' 1 STATE W,- ZIP (/$aog <br /> OWNER PHONE: (i-lac) p-on - /39--,' OWNER EMAIL: ba t &o('j�ltci •(eon <br /> CONTRACTOR NAME: K iY b �•aJ� i(\.c• �.! <br /> CONTRACTOR ADDRESS: STREET (/2s- X941- 9- l 3 ) SUffj�� JJ' G <br /> CITY LAA AA oc, STATE WL)" ziPq&3 <br /> CONTRACTOR PHONE: C{ac (9--W-S-11."3 CONTRACTOR EMAIL: ;L' 9 k & > •n aylr. <br /> CONTRACTOR LICENSE#(REQUIRED): f 1 IU&S H f a A CITY OF EVERETT BUSINESS LICENSEIREQUIRE .agO9- <br /> PRIMARY CONTACT: KOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 21 dU8 1 V <br /> t c\aber CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: ^ is-c0t ,' <br /> Proposed Use of Building: Heat Source: Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-DetachedSSFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Com • cial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel jARepair ❑T.I. ❑Sign ❑Sprinkler •:- oliti.' ■Change of Use <br /> DESCRIPTION OF WORK: <br /> \41c,. xitJT" ltco( I-( <br /> DVILDING PERMIT#(if applicable): <br /> ASSOCIATE U R <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 /> 1 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 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.efore be' .autho 'ed under any circu stanc-.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> an. c,mply %h the S Con ors -, 18. �R an• =6.200A WAC. <br /> /_ I City of Everett Official Use Only <br /> / <br /> " rI J 1 // PERM t ` 02 � <br /> •wn• •ithorized A ent Signa, re / `/Date!/( �iL (Revised 9/23/2016) <br />