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IPERMIT APPLICATION— <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 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: I'�,►, CIZO IA)i D re"- Eli I eg"Ti r PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Sleetieet Cy4iM( TENANT NAME(If Commercial): Wilt <br /> OWNER MAILING ADDRESS: STREET S/2. <br /> ve.1CANNA. De. I. <br /> {{ CITY e' 4. STATE W4 ZIP 998.2.41:qOWNER PHONE: q,25-- -c OWNER EMAIL:5 / 06( , 442 67#0t <br /> CONTRACTOR NAME: /l/A <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: OY OWNER 0 CONTRACTOR Al OTHER(Please Specify) I3f2.o3'bf-4/2- , 4L E& W I.DEt/ <br /> CONTACT NAME:/ � CONTACT PHONE: 1 2 22 j (ci <br /> kk / <br /> _ r' ' lC ENt4 L CONTACT EMAIL: Ly/A-1.-1.-yV1Ms NI+ Co Y1/� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: RCS f D ►�4L�. Contract Price of Work:$ —l�l bOO, <br /> Proposed Use of Building: ke-6 t 1:00-14 f6A Heat Source: ❑Gas IglElectric ❑Other <br /> Building Type: ❑SFR-Detached IgISFR-Attached ❑Duplex ❑Multi-Family##of Units: ❑Commercial ❑industrial <br /> Type of Project: ❑New I$IAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> A l)D t rsi/c I gro ghO V&/ I .Bi°r°rlt-►2.oOw -L N' f A-RA t Ti O 54 SP <br /> Prn1 t giev / D r n/4.11.t — <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 test 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 I Bathtub Urinal <br /> Gas Piping Boiler 2 Lavatory(\Nash Basin) Drinking Fountain <br /> Water Heater Refrigeration i 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 /> I Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Number 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 /> (O —/‘ O 00 <br /> • ner/-. o .Agent Signature Date (Revised 5/20/2016) r , <br />