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PERMIT APPLICATION BUILDING / MECHANICAL/ PLUMBING /SIGN/SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 7111 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: Zig f4 g f s'T fun&J(kk{,TZdPROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: gefd krx A :5 0, TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET f13f 4 (Jf4fIV, (H/ CITY Se /e % STATE bj A, ZIP A??7 7 OWNER PHONE: 27046 / - ia5e9. OWNER EMAIL: AD 474itIDv kiv, .1 ak-'. CQ y1 CONTRACTOR NAME: /9 0)/ 14.60 042_ / M.42 /li f CA-IR-- CONTRACTOR 4-I a,.CONTRACTOR ADDRESS: STREET y,4/<9 /4 in- CITY e( -/4' STATE - ,l¢- ZIP , r, .3 , CONTRACTOR PHONE: yf '-yz "©2 B CONTRACTOR EMAIL:4cty 44 bale ce)I Ze,iroutyde, ' 6.44,1_1 I I CONTRACTOR LICENSE#(REQUIRED): 'U J if 8/r/$3 L/t)er CITY OF EVERETT BUSINESS LICENSE#(REQUIRE ri): /^''CI/� PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) `��/'.._ CONTACT NAME: CONTACT PHONE: Zyl .--. � Aja ze 4Vilm Vit, ' �2. ' #042:3CONTACT EMAIL: BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work:$ , la-6 0 Proposed Use of Building: /6442 ?...*%c_ br Heat Source: Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ISFR-Attached ❑Duplex ❑Multi-Family#of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel Repair ❑T.I. ❑Sign ❑Sprinkler Demolition ❑Change of Use DESCRIPTION OF WORK: 7C-az. /)__a� l fl-5 A4_1/ r ASO ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New_ Addn _Alteration _Repair Type of Project: New _Addn _Alteration _Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER/SUPPRESSION SYSTEM Chemical or Water I No.of Heads 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 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 Building Offi'a before be' g 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, and I com. /with e S to Contractors Law 18.27 RCW and 296.200A WAC. /f LLL City of Everett Official Use Only / PE� �� ry �r NQS A-- 04 C) • • er/Authorized Agent Signature Date (Revised 9 9 9/23/2016)