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,filiPAfr-/-_,-.1 <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING /SIGN/SPRINKLER/DEMOLITION <br /> �`� I 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 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:/c NJvvk ,/h l/'L( Jr- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision (('' �� Lot No. (attach copy of long legal description) <br /> f CONTACT INFORMATION <br /> OWNER NAME: v�/„ s1-1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET JjOO'q J1/C7d(�j� g.k 6( (r` <br /> CITY f ve v•-re l STATE 1.(//4, ZIP 9rQ Q <br /> OWNER PHONE: c/o?3- 9€07-'----72-CtiOWNER EMAIL: <br /> CONTRACTOR NAME: �''Vl.) ,50 f) o4 3c1 LF1©r(4 <br /> CONTRACTOR ADDRESS: STREET p 3 r,:,, , 7 / (( <br /> CITY � , STATE C�� ZIP <br /> /' R2 <br /> CONTRACTOR PHONE: tip 5--..."3y 3—55-6 4 CONTRACTOR EMAIL: ft.,5 }tcpl, 50_5 ,4,-k5 , ( o <br /> I <br /> CONTRACTOR LICENSE#(REQUIRED): � S -d•�1 / 6) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) `. I <br /> PRIMARY CONTACT: 0 OWNER trICONTRACT416 0 OTHER(Please Specify) �-7 <br /> CONTACT NAME: '�^ �[ ( CONTACT PHONE: It *&•-•r 34. -J.5�k, ,6 <br /> / ✓' Y" ,Gcv Y� e CONTACT EMAIL: idC,/?s -SOVA 41 s ♦ fr a r <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: `/9t9 7 <br /> Proposed Use of Building: Heat Source: ' Cas ❑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 WOR�C�� 6 / `` 3 e f t <br /> Rei <br /> //�,�JJJ C_S /i/1 -143 Cry V t/ 'L. T/�( lJ �'( <br /> 6veziev- a hoc,..s,e -eq,(/- 73 'c'c? e'v. -‘‘,.‘,./-e,-- (r'A \ QLS° <br /> ASSOCIATED BUILDING PERMIT#(if applicable): Ade <br /> ��y�� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> J <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 /> 3 Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> l 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 ofAO <br /> Everett Official Use <br /> eOOnly <br /> � <br /> . ���.1 12`aS a PERMIT# `"G2— <br /> Owner •u"?¢ed Age i at'1"ire Date (Revised 9/23/2096) <br />