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PERMIT APPLICATIOf— <br /> BUILDING/MECHANICAL I PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> "IIIPA 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 /> PROJECT SITE ADDRESS: F'S I g 77 41/e_-(i ?5Z-01 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Cif). '? i' TENANT NAME(If Commercial): NO <br /> OWNER MAILING ADDRESear STREET Oh rive_ (AJ <br /> g'fr<2.,rCITY STATAJcl ZIP,IgCP <br /> OWNER PHONE:92 3C77-9' C 7' OWNER EMAIL: \(' f Il/ re.0„.7J2o50ya „G•co r-t <br /> CONTRACTOR NAME OLD <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: .OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: /Z] r <br /> a'7- 79 7 <br /> eq--(A.- Fe,igyr-- CONTACT EMAIL: K/�v(rP./g� tJ� <br /> �`/ D O'Co <br /> v BUILDING PERMIT APPLICATION <br /> Existing Use of Building: S'7 j1 S Contract Price of Work:$ --1400-00 <br /> Proposed Use of Building:'1` Heat Source: ❑Gas lectric ❑Other <br /> Building Type: Q FR-Detached ❑SFR-Attached ['Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel *Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DES RIPTION OF WORK: <br /> race A 6'll. eke, f o f F/ct WCX., C 7'152-- Flo )4`° <br /> ge-pc_ce some. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): y <br /> T,,, 1 fe7--5Z1 � n <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn _AlterationRepair 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 /> Gas Fireplace Wood Stove 4 V Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting 4' -Dishwasher ' Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> ..ktsv, <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM f7i,.vtiopJ F{c2-8Y" <br /> Chemical or Water I No.of Heads One- or^ke "' <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 th State Co�actors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 1 / <br /> © PERMIT#„ �� 041+-0 <br /> - / `oo� <br /> caner/A ho i �d Age Signature Date (Revised 9/23/2016) <br />