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PERMIT APPLICATII <br /> �/— BUILDIN ■MECHANICAL/PLUMBING/SIGN.G <br /> PRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION` <br /> PROJECT SITE ADDRESS: ace3& iv_Rtr7- t-'� if,Zv PROPERTY TAX#- <br /> i.IJ r� a rLa Lr�v 2c rT; ev,4 <br /> LEGAL for new construction: Short Plat/subdivision �4e,' t.. Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION, <br /> OWNER NAME: 56 fdiv TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3 ePto A J (- $I Af0 2 p <br /> CITY G V B R C��/'� r STATE ki,Ar ZIP Q p 20 3 <br /> OWNER PHONE: �Y R/NtIR►N -CoNs7 /N4 1.4W OWNER EMAIL: <br /> L/2 '-?30- IftO� R.►Yraluwlno./F.Rlrreo2inr " j$ctiwrer.rcrxn <br /> CONTRACTOR NAME: 61-"1>:£ti11 g£?LR.Y IN bu St.re <br /> CONTRACTOR ADDRESS: STREET (egSO 5..L.4ShtAIJ PKWY <br /> CITY • riI'L.n/4)A 1 S STATE 6c/,4 ZIP q82,48 <br /> CONTRACTOR PHONE: 3(oO - 346,- 3 y 4,7 CONTRACTOR EMAIL: Aso ow S�Gri CvG arri valrzkY,comet <br /> CONTRACTOR LICENSE#(REQUIRED): G Rat L N I L €i i(,M i CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): S' L 3q <br /> PRIMARY CONTACT: 0 OWNER tit CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: '�4SoN SOCA CONTACT PHONE: 36,p—q- — (o <br /> /y <br /> _ CONTACT EMAIL: ASd/U.St1 L./-f eviztrA,j BL te,r,Coofri <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Ciro Contract Price of Work:$ ]may 3, 0 0 <br /> Proposed Use of Building: No ('rpt-4-n1C Heat Source: OGas 0 Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: EfS £ni5%>til(� C-rzcr.g Fc c--' Gl i T�'�- S KS c✓/ e_aS <br /> /U£.w Cert.-) E iZ Fw c � Coc' ,R1- rc .S €12 S. ,r4.1. ";-.4., J£�✓ t P i i J - Cd tir.0 E c.i JiCrs <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 /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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 /> PERMIT# <br /> 7-O/ f <br /> Owner/A `'"""'•" '-ignature ate (Revised 9/23/2016) <br />