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OTETT PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 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 /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:--in-) C�•.//Ai it/ PROPERTY TAX#:UC,5 7 / i CC)`O�J/ -XD <br /> LEGAL for new construction: Short Plat/subdivision f' Lot No. / (attach copy of long leglal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 8,S1 r<c• Cs.)y tt rj (c;j;_ri fA,I(,. TENANT NAME(If Commercial): -- <br /> OWNER MAILING ADDRESS: STREET Y . &5 U/ /"? 4" <br /> f‘l LA'S t//`L- ( CITY I�STATE ZIP rte'l)2 7 0 <br /> OWNER PHONE: 4 �1 - E 7 ` �,. S 5 / OWNER EMAIL: t' Il11 X //o/t CS e:1 (_., /`fr71/4 , ( CU!°7 <br /> CONTRACTOR NAME: /S V$7,1/Z.•6 ( LJS%7t ('1 <br /> CONTRACTOR ADDRESS: STREET ,Sid-' <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED):/ J)7f( `pj 6(_ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):; 3 SJ(C` <br /> PRIMARY CONTACT: 0 OWNER (CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: /rU 6 U�xt� CONTACT EMAILE if ZS (Y 6.5"-.s---/ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ ,,A ) O, I CX'-- <br /> Proposed Use of Building: j / a_ Heat Source: ❑Gas Electric DOther <br /> Building Type: 1SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: (ew DAddition 0 Remodel 0 Repair ❑T.I. ❑Sign DSprinkler 0 Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: r(),A6'7' <br /> ),A 7 )c r /)2_C-c,/ f,./..— <br /> ASSOCIATED <br /> tASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project:1--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 3 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> 3 Gas Piping Boiler y Lavatory(Wash Basin) Drinking Fountain <br /> / Water Heater Refrigeration / Shower Floor Drain <br /> / Gas Fireplace Wood Stove / Kitchen Sink&Disposal Grease Trap <br /> 7 Gas Range Ducting / Dishwasher Roof Drains I <br /> / Clothes Dryer Hookups Other: , Clothes Washer Medical Gas <br /> Range Hood N/. Water Heater Other: <br /> / Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number 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 I <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 /> m <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. 1 <br /> City of Everett Official Use Only <br /> PERMIT# <br /> c, 1 70 el .•,00 4.7! 1WL,I.J26U4:174-7A Cts//7‘ 15.-- i1 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015)/- 1 <br />