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PERMIT APPLICATION <br /> "IIPBUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> voay <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 /> (Blue or Meek Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 0 6I CA (Z -J - PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: g_e_4_1,---‘ 1K-e-i r LA. ) t vg`»._ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ')Qt -- 1,61.,`�--'Ls`1.. (0-- <br /> CITY q <br /> CITY Cr=.-_-.0 'C..ir ✓�.� — STATE Li .J ZIP ,.)-6)1 <br /> OWNER PHONE: -:36 . II 6-4-) OWNER EMAIL: <br /> CONTRACTOR NAME: /1 6 J/,l a f'-Y... `j) ) rf'<f..,((L_;`�.'"t.K-) •'P-`/4 L. <br /> CONTRACTOR ADDRESS: STREET Ji / /-7 4-4-'`1U 6/ 0 °`_,„,, <br /> CITY / 11 t 1,-- ` t.e'"4_. STATE -�fr:t.#',. rt.-"_ ZIP 6's- s�,.�) <br /> CONTRACTOR PHONE: of -- '3 3 5- 4)4 CONTRACTOR EMAIL: /10 J'G�`�f r aiiiveiA <br /> CONTRACTOR LICENSE#(REQUIRED):j')0 rr151)tom(S ). ,CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):69L , 7 L/ 1 <br /> PRIMARY CONTACT: 0 OWNER °CONTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: tia- ` ¶z-,/e)& <br /> CONTACT EMAIL:,Jj ,(- .da ,. e Y � eJ <br /> 1 <br /> BUILDING PERMIT APPLICATION // <br /> Existing Use of Building: Contract Price of Work:$ )�7`T4 a671-1) <br /> _.-) <br /> Proposed Use of Building: Heat Source: ❑Gas ®Electric ❑Other .. <br /> Building Type: ®SFR-Detached FR-Attached ®Duplex ®Multi-Family-#of Units: ❑Commercial Dlndustrial <br /> Type of Project: ®New ❑Addition ©Remodel pRepair DTA. ®Sign ®Sprinkler ❑Demolition ©Change of Use <br /> DESCRIPTION OF WORK: l "? <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 Adds 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 /> h A/C—Air Handling Units Heat Pump Toilet Backfiow 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/BarlMop/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Chemical or Water 1 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 properly 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 /> / City of Everett Official Use Only <br /> ii t <br /> -3* ()-g-1 ' PES• ,o3 _ �L <br /> 6( 1 1 1 <br /> Owner/Authorized Agent,1---) <br /> J nature ,, Date (Revised 9/23/2016) <br /> l/? <br />