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PERMIT APPLICATION <br /> °#'/..s!'//1 -0.‘' 1// -"A.-11 . <br /> BUILDINGmECHANICAL/PLUMBING /SIGN JR' INKLER/DEMOLITION <br /> _ CITY OF EVERETT PERMIT SERVICES <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 /> i(Blue oir Black ink 4iilyF Please)----ft-44:-2,‘ ,PROJECT RITE INFORMATION -` <br /> PROJECT SITE ADDRESS: 39;/ hon, c, ,�� . C PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision / Lot No. (attach copy of long legal description) <br /> CON'1'A04FORMATIOI <br /> OWNER NAME: TENANT NAME(If Commercial): 6:1„-f-k-D, (Jj v f(2is&. <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: cj"` =€E ,c <br /> CONTRACTOR ADDRESS: sTTRT /Qic( Pt a'y l,'q w 4- <br /> CITY �_ t��;G.tt�ed STATE �_�-- ZIP g�nJ <br /> CONTRACTOR PHONE: 4_)..."5--)- 7- 00y 2_. CONTRACTOR EMAIL 5 S ® yv5 c, '01,y, <br /> CONTRACTOR LICENSE#(REQUIRED) 5, i CITY OF EVERETT BUSINESS LI ENSE##((REQUIRED): 2o <br /> PRIMARY CONTACT: ❑OWNER NTRACTO� .� ._.,_,_ .� <br /> 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4-2-5-3—.,7 -00q' <br /> „Tavw-c Pa)4(---- CONTACT EMAIL: / <br /> BtUiLDING PERMITAPPLICATI©N; <br /> Existing Use of Building: Contract Price of Work:$ Ce4o <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: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ['Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> 171 ctet 1( 04/10-9) L.,(.11- IV/ 1.-- --.4A7 LI )1.fer 7 it(e) <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 #°f List of Fixtures #°f 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 1.3UPPRESSION SYSTEM ', <br /> Chemical or Water I INo.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confine 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 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 0 ent Signature Date (Revised 9/23/2016) <br />