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PERMIT APPLICATIC <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ 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: 3002 l,), Ot( Ito-o PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ( EhJ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET v boa (jJ CAS0 �A> <br /> crrYC-1 STATE L1ik ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: (A)( i S Flee `1�12earc-n IJ <br /> CONTRACTOR ADDRESS: STREET /ckpgo tJ Cj' 0 <br /> CITY 26--- 01k) STATE L.!' ZIP q805-2- <br /> CONTRACTOR <br /> $052CONTRACTOR PHONE:4 2 ) 8Fct CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): We5-ra 136 QF CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): .cSS3 <br /> PRIMARY CONTACT: ❑OWNER GKONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: fA � �C�� CONTACT PHONE:(, ') S-79--294/-7 <br /> CONTACT EMAIL: AtiTtkv,_)--e,(.6'ts-r G.S 5 11),1/4..) <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 511)(ZA6E Contract Price of Work:$ 41,Z.50 <br /> Proposed Use of Building: g'b �4 Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: fommerciai ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: Cie 1 r„..\90,) \jgowl T-6fi2toIf.l s 6.1 rsH <br /> C-6711- <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 /> 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 /> Number of Heads 15n <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 /> 1-2 /3 ‘-1 (/5 6:2-1 <br /> Owner/Autho zed Agent Signa ure Date (Revised 9/23/2016) <br />