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PERMIT APPLICATION v <br /> BUILDINECHANICAL/PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> Niit, 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: 2-7 23 1 21.1'` ‘ PROPERTY TAX#: 2 c1Q S-1700 103 20D <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: E VEee 1 1A-ov.) lj 6 rfirr4 , TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 7(0-7 cot \ AV nL <br /> CITY % E-e. r STATE 1A. ZIP 9 g 2_0 k <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: T-g D <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: - 25 - 2J"3 1 S TOO" ©P > <br /> 5 k L - e.. CONTACT EMAIL: ,f r ,,-Q y r,k e ,, 1,,, . (5 i / <br /> \.J _4 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Av,if,-4-rti Nf f Contract Price of Work:$ 6-000-7175%." fo 70 0 <br /> Proposed Use of Building: SPs-n4a Heat Source: OGas ❑Electric DOther <br /> Building Type: OSFR-Detached OSFR-Attached ODuplex QMulti-Family-#of Units: Li OCommercial Dlndustrial <br /> Type of Project: ONew DAddition DRemodel ORepair DT.I. OSign OSprinkler DDemolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): c. ` i.rzs.r 4 c_x-e-v-4 a, o-vprt-,,c.3)1/4,-3 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New— Addn Alteration _Repair Type of Project: New Addn Alteration _Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> 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 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 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 /> 2y_ W <-7- 3- iPERMIT# ..?,no.... b49, <br /> p, <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />