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PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/ PLUMBING /SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> grr 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I 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: VII' eA ifk/e-$ `,) {/p l l (�O P PROPERTY TAX#: . <br /> LEGAL for new construction: Short Plat/subdivision f _ Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: it741.1/e 0,-ii i .14 c, TENANT NAME(If Commercial): goers (fli cQ 1,..L.. <br /> OWNER MAILING ADDRESS: STREET f( ,Cd-Ziet. /!� �J <br /> CITY K-0(../ L0 l/ STATE ZIP <br /> OWNER PHONE: / OWNER EMAIL: <br /> CONTRACTOR NAME: W(,fly{/' cEr/r) j \/Y -1-4,r (j J7/ <br /> CONTRACTOR ADDRESS: STREET �3 At() ../As.--(e(s..vr. 5 <br /> CITY PCIASTATE ZIP tf 4> <br /> �j <br /> CONTRACTOR PHONE: ( 3 L ., co, CONTRACTOR EMAIL: s G.,la L ,f4'�J ' 4 r CUI'rt <br /> CONTRACTOR LICENSE#REQUIRED: CITY OF EVERETT BUSINESS LICENS # IRED <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR igOTHER(Please Specify) /fit <br /> CONTACT NAME. CONTACT PHONE: C 6 qf c <br /> � CONTACT EMAIL: - I�.... (z�q ?/ DS.G <br /> C"!7 �I 7 <br /> BUILDING PERMIT APPLICATION " <br /> r <br /> Existing Use of Building: Contract Price of Work:$ 1 LIC15 --ta 4 j,c,c(c <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. DSign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: -- <br /> Y `G &tOi,e- hxo1 ilerL �,'Gw U y <br /> ASSOCIATED BUILDING PERMIT#(if applicable):' V P3)('3 F c3 <br /> MECHANICAL PERMIT APPLICATION UMBING 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 /> 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-ny 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 ith the State Contractors Law 8.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> iml <br /> r <br /> to/e/ie 15bo31 <br /> O n uthori' .Agent Si;natu - PER(Revised 9/23/2096) <br /> (....g5 <br />