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PERMIT APPLICATION <br /> '1111111 BUILDING/MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2 pu �'(���Li sr -- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> C Tim 4c.,4-tr0 CONTACT INFORMATION <br /> OWNER NAME:EvFie)..gir Cor/e/M.nvi deTENANT NAME(If Commercial): f\ r $ WAS_ 3 4"4/7"-:/ <br /> OWNER MAILING ADDRESS: STREET 7pco jbu92r 5772_ <br /> CITY Ej/S/citSTATE ZIP <br /> OWNER PHONE: �4c•. 3$7, /Of('(' OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET a <br /> CITY UVJ STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR�rEMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED));�I ( ara-C`LK9CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 3(o <br /> ^ <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) � 4-C/-6/7"&r— <br /> CONTACT <br /> — <br /> CONTACT NAME: L hot- <br /> PHONE: Oto 2 n 63 t/t <br /> Je-et/ e71 h - ,) CONTACT EMAIL: ,f(?Skfr, 04/)05. Gv6.1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: B Gt91l�v Contract Price of Work:$ X7'7, L/?3 <br /> Proposed Use of Building: 5_ C_„/ c-- Heat Source: DGas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel DRepair DTA. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 17,1/0" o2noir Cod 3'ES F&i -✓ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): tOi A4"' <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New _Adds _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 /> 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 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# �tgo g. <br /> O ner uthor Agent Signature Date (Revised 9/23/2016) <br />