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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 ( FAX 425-257-8857 1 (E) everetteps@everelwa.gov I www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: iosz!ti Aue. AiPrr lyo <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: vu,,\S /A,114t,44t C TENANT NAME (if Commercial): <br />OWNER MAILING ADDRESS: STREET "� S r Z I <br />�/�j <br />CITY STATE WA zip Ct$ ZQ <br />OWNER PHONE: -& <br />OWNER EMAIL: D11.�ldS Gp �b. Cew <br />CONTRACTOR NAME: Cp Y tK <br />CONTRACTOR ADDRESS: srREET p (Z AEvim eV W = 1Y <br />CITY V STATE `( A zip & 2 7- <br />CONTRACTOR PHONE: Z 5 - —&1 S-- CONTRACTOR EMAIL: f-o'Y C C a.s )',I w, a' I o Cpw <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 5/O `%3 O <br />PRIMARY CONTACT: OWNER ❑ CONTRACTOR [3 OTHER (Please Specify) <br />CONTACT NAME: <br />[- A O V-k-6 S C0 <br />CONTACT PHONE: Z0(Q - �O I - (Q c <br />CONTACT EMAIL: -r l Lo,,kA S ,_.. Co 42 �LL Co L-A <br />BUILDING PERMIT APPLICATION 41 <br />Existing Use of Building: <br />Contract Price of Work: $ WjjJ00 <br />Proposed Use of Building: 5 idle- <br />Heat Source: ❑Gas 0Electric 00ther <br />Building Type: ❑SFR-Detached AFR-Attached ❑Du lex ❑Multi-Famil -# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New OAdditiod ❑Remodel ❑Re air ❑T.I. ❑Sign ❑S rinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />�u.1� e4 ex . �.� L� t.� s e. cl o k, �-z.L ;A , <br />1 J <br />ASSOCIATED BUILDING PERMIT # if applicable): <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New Addn Alteration _Repair <br />Type of Project: _New _Addn ,_Alteration _Repair <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />A/C - Air Handling Units <br />Heat Pump <br />Toilet <br />Backtlow Preventer (Inside Bldg <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory ash Basin) <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />Kitchen Sink & Disposal <br />Grease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />Other: <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />Water Heater <br />Other: <br />Exhaust Fan <br />Sink Service/Bar/Mop/etc. <br />Other: <br />SPRINKLER <br />I SUPPRESSION <br />SYSTEM <br />Chemical or Water <br />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 wing from the <br />Building Official befbNjwhaQ 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 a State ontractors Law 18.27 RCW and 296.200A WAC. <br />Z City of Everett Official Use Only <br />PERMIT # <br />(Revised 912312016) <br />