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elPPERMIT APPLICATIO* <br /> BUILDING I MECHANICAL/PLUMBING/SIGN/SPR! ER/DEMOLITIO <br /> CITY OF EVERETT PERMIT SERVICES �� ,, <br /> _ 3200 CEDAR STREET,EVERETT,WA 98201 8 `4'l <br /> (P)425-257-8810 i FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.e ettwa.govipermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: /du, l g1 f ve 3 &Je ' (A)0 cogo, PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot Na (attach copy of long legal description) <br /> CONTACT INFORMATION < <br /> OWNER NAME: A V ILiyv, 6 c.. i TENANT NAME(If Commercial): 5 .,fer kq 14n^'5 <br /> ei <br /> OWNER MAILING ADDRESS: srRe /p2 f j ma" ic)-r6s a,,,, 5f �" <br /> CITY Eve refySTATE ciA ZIP "20)08 <br /> OWNER PHONE: stay- 337— s`aY_3 OWNER EMAIL: SI fvPr(ok w c 0 Tel54-01.wort V <br /> CONTRACTOR NAME: $ R(,JA.� <br /> CONTRACTOR ADDRESS: 4 STREET 611 11 Pirz.)`jam o l Sf" <br /> CITY 4 ( a4D,;4 STATE 114 ZIP Ila.314 <br /> CONTRACTOR PHONE: '703-,L('/"Q3 till CONTRACTOR EMAIL: SCcr-kr cst 5q?4.)cif r. r.fjy/'' <br /> CONTRACTOR LICENSE#(REQUIRED): ? 3W �Yi 9 apt � CITY OF EVERETT BUSINESS LICENSE#(REQUIRED <br /> PRIMARY CONTACT: ❑OWNER 'CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: rIi,vC (-t e. CONTACT PHONE: 703_c)Si_ /('I <br /> CONTACT EMAIL: SLclr4ere 5 cic,Wim. -t WW1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ iTJ?O 6M <br /> Proposed Use of Building: Heat Source: ❑Gas *Iectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex Multi-Family#of Units: ❑Commercial ❑industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel IgRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> i(epIcte p6itifvletie pa'T(oir rJakr (..les .3fitt P <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING 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 /> A/C—Air Handling Units Heat Pump kk Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater l`k Bathtub Urinal <br /> Gas Piping Boiler Ay 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 t,Z) Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: L`2 Clothes Washer Medical Gas <br /> Range Hood % Water Heater a Other: \kbi e <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other. V b <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> !Chemical or Water ( 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,ori am authorized by the owner of this properly to perform the work for which application is made, <br /> and!comply with the tate Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> .: j ib' P A'R i � 'r C <br /> �%"er/Aut, riz='men ign.ure at (Revised 9/23/2016) <br />