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PERMIT APPLICATIO— <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN/SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> (1/147T 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: $ca t S A\Q I[{L. P PROPERTY TAX#: 00 00 13 00 0rVln <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 6121u6. JOob TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET SO($ AU%C2 U JI V <br /> CITY eUeF'1" STATE w i\ ZIP 98,006 <br /> OWNER PHONE: 4 Zs - $ 3'7`j 8 OWNER EMAIL: C2PtG®WoOD a�t,� jyl A I L o ( pv <br /> CONTRACTOR NAME: <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: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: � y CONTACT PHONE: 4z5-2A 8-37S-8 <br /> CR! WoO* CONTACT EMAIL: e t6o moot @ ()ARIL • m.. <br /> BUILDING PERMIT,APPLICATION <br /> Existing Use of Building:5F9_ Contract Price of Work:$fa) , 00 <br /> Proposed Use of Building: $1'12- Heat Source: XGas DElectric ❑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: cervicqc gocnvk onit ce- - IA)ku_ . /,�JFlo_ 1'4" sky W wow r Le?IGTN&J aviisoda <br /> WIfiQQinI 6101,A 4r7,3 S'enl iCrRLt" „ pt 4/ W/(JQvW /nl M1Kct-(1-QMH• gernvAle 1Ll rdt(f <br /> P-Et-oc.frMrJf inAc Pt J&G)nI4,/as1PL New Ca 44ct #*JcG OOw,.i 4(LPc cV ` i/J 14-trO"e.+ kS ,r1. <br /> ifrotteXe A"- 6P4Fv�tUco-C-::s w/fieri 5th 'ltooS, gePiAce DE04 vv( <br /> CO/J 2c-,PA,�. <br /> ASSOCIATED BUILDING PERMIT#(if applic ble): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn X Alteration _Repair Type of Project: _New _Addn X 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 4 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 /> I Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/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 a, ,orized 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 l comply w' the '.tat-C, actors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT py:FA <br /> /1 Og/0//2.0(8 ) ©S <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> 47). <br />