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PERMIT APPLICATION <br /> 70111110;/- <br /> ,. UILDING I MECHANICAL/ PLUMBING I SIGN I SPRINKLER/ DEMOLITIONCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) P :OJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 27 lq GQh / 47e (PROPERTY TAX#:. <br /> LEGAL for new construction: Short Plat/subdivision // Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: kQ 57,4-0 j�/ $i VV/Vail TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1/133 <br /> 33 1 2 p/ Jr / <br /> CITY G/ f 4 E/ �-1 STATE (`�Q �ZIP ✓G/2 ✓(5- <br /> OWNER PHONE: /25' 7, - O0-75" OWNER EMAIL: dj ®I 0_5 7,,e; ()/41/t7 <br /> CONTRACTOR NAME: DIA)Ya <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> • <br /> BUILDING PERMIT APPLICATION00 <br /> //�� <br /> Existing Use of Building: Contract Price of Work:$ ';0(0 00 <br /> Proposed Use of Building: • Heat Source: ❑Gas 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. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 1100 1N / 4 47i C.7PA--,'L--ASSOCIATED BUILDING PERMIT#( ppif a licable): C"V4'1/t <br /> C —,e 'HT) <br /> �v �/ <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 /> 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 I SUPPRESSION SYSTEM <br /> Chemical or Water 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 l 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 /> PERMIT <br /> r - ic2/o. /tom <br /> Owner/Authorized Agent Signatur> Date (Revised 9/23/2016 <br /> (#.0 <br />