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PERMIT APPLICATION! <br /> 'SIIIPP0/44*11,—/—g: <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> vidad <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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 770 / c45�iJe ('R P L`'�/�-e7-7 W,r1eop A2T : <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: V/74-1-0 a g o rnY4/< TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 6 c) g3 ihJ7 s--4._ (/.edcz,— L���l 9 g;4:::, 3 <br /> CITY et/ek % / STATE Vii'/ ✓-:: ZIP ?6!.c <br /> OWNER PHONE(( 5/ 87O-tS 3 '1?-2 OWNER EMAIL: <br /> CONTRACTOR NAME: 1/> A2 of / J07'�/4/< <br /> CONTRACTOR ADDRESS: STREET 6 d 3 / S'71^ £v-2 e77- ova¢ <br /> CITY �v -e%/ STATE �� P ZIP 9 L3 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: VOWNER ❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> If, 14,1-4,g 1 io O)2y.47 CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 02/ SO 0 <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: :New DAddition ❑Remodel ❑Repair DTI. DSign ❑Sprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: ivP�j ,c--c.t oe /2 A.c .._ e{z., j d2_5 / _/6,,,C/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 #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 /> k Forced Air Systems Unit Heater Bathtub Urinal <br /> t 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 t 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 1 am authorized by the owner of this properly 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 /> PE/-'' --woe? r P/a,2 C)//7 I e <br /> scr.5:t <br /> o .- orized AgA ature Date (Revised 9/23/2016) <br />