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OJETTPERMIT APPLICATION <br /> BUILDING / MECHANICAL / PLUMBING / SIGN I .yrRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 9 o -. A ) aVDuve,,A [ live (JO-1"Pe i PROPERTY TAX#: -2-7O q-Co2O// 00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No._ (attach copy of long legal description) <br /> CONTACT INFORMATION I <br /> OWNER NAME: l,(v1 S.14,-k CVA© TENANT NAME(If Commercial): �'�/�e"hf DI( t L , <br /> OWNER MAILING ADDRESS: STREET /.� p C °//�" 6 c)(h Ole- (-' (� ) [� <br /> CITY t j k c---fL STATE ZIP (i2.1-f <br /> OWNER PHONE: 404— <br /> - 3$I —41.2:7- )r� /�O�W/NER EMAIL: <br /> CONTRACTOR NAME 7 ) o t I ' e 'f/►' �A 6V•i d,w• <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP y���� <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: 1 l'/�-ti <br /> CONTRACTOR LICENSE#(REQUIRED): ' , �� L l 3 M 1` CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):T° 21 <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR lJd OTHER(Please Specify) tc <br /> CONTACT NAME: �( /�� CONTACT PHONE: j,-/,•—� -- �q ,� �-c` 5,G� <br /> l U`� CONTACT EMAIL: '7/ ,/ -� ,,F <br /> �;/UClwl c f r pG �7/4/7(ei - (0„,1 <br /> BUILDINGPERMIT APPLICATION <br /> Existing Use of Building: HCizt Ls/A(r` _ Contract Price of Work: $ `Y4 J� '- <br /> Proposed Use of Building: /(4-.{-Ar LS 7,O..e/t Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: E ommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition Remodel CI Repair DTI. ❑Sign DSprinkler ❑Demolition DChange of Use <br /> DESCRIPTION OF WORK: , <br /> capita+�� G 4 �1V�l���i rllal - .0.51,4_,,,i+ 6.,,,,,,,,,,,o.& paors <br /> pa4/V � 6',4, e fr" '4' C.,�/ev <br /> ASSOCIATEDBUILDING PERMIT#(if applicable): <br /> -- <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 /> City of Everett Official Use Only <br /> --------__.. <br /> Vk//4 PERI�FITj 1 v7 — O33 <br /> OwnerlHuthorized Agent Signature Date (Revised <br /> -9�9/23/2016) <br /> (y_27) <br /> ) <br />