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PERMIT APPLICATIO• <br /> /111111P <br /> w, BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 2 • 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwagov/perrnits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 7,9,0 7 - /9 /4_SPROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision NJ SIP Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: c51.-PFJ , Jy 5 TENANT NAME(IfIfCommercial): <br /> OWNER MAILING ADDRESS: STREET/0.70 f� 6/./ 7-7- 7,#)/j//2 <br /> STATE J/ ./e/C-)� � CTz e JK_ ZIP 9CX "-/1-/ <br /> OWNER PHONE: 1‘,(5 R.s:5 „?9.0(,) OWNER EMAIL: <br /> CONTRACTOR NAME: Aye/ Zoo i7q ev <br /> CONTRACTOR ADDRESS: STREET <br /> 1PbZ5G)x ___&36:, <br /> Zz - e ✓/—i tr- CS <br /> , STATE/�(iC ZIP /V,./S. CT <br /> CONTRACTOR PHONE: .,/,,16-534.2.0.1j// CONTRACTOR EMAIL �jleei7,,dhi y 91&1 "( Y1<? <br /> CONTRACTOR LICENSE#(REQUIRED): RI 6L`7-f-/ 0,41 g b CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):/06,260 <br /> PRIMARY CONTACT: 0 OWNER 4CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: LJ 3361.,2N2 <br /> .0„V) LOW. CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: rgsk6 17 cam, Contract Price of Work:$ b„.2-DO <br /> Proposed Use of Building: Heat Source: ❑Gas Xttlectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex Multi-Family-#of Units: 14 ❑Commercial ❑Industrial <br /> Type of Project: 'New DAddition DRemodel ❑Repair DT.I. ❑Sign DSprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OFIi/h3 <br /> ORK: <br /> CI Ase.,5E )/1.eat pumio /- 915 <br /> / -/gi <br /> ASSOCIATED BUILDING PERMIT#(if applicable): /-0'r761, mid <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 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 /> (-1�, City of Everett Official Use Only <br /> 4. % ---/// CgOV-032- <br /> Q1 / i <br /> PERMIThorized Agent Signature Date (Revised 9/23/2016) <br />