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PERMIT APPLICATION <br /> IIII* 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 1(E)everetteps@everettwa.gov( www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: Z000 7b Jfg ST PROPERTY TAX#: 2_9(_ S--) 7600DOOD <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: F.v ; rz-NMM , Chi TENANT NAME(If Commercial): <AP- E - <br /> OWNER MAILING ADDRESS: STREET 2rDW ' e s"c, <br /> CITY EJ,F f STATE ft.../A ZIP c -R®2r <br /> OWNER PHONE: (( OWNER EMAIL: ) <br /> CONTRACTOR NAME: i"} 'E. re°6 c(, C,0) :-.CAjc_, <br /> CONTRACTOR ADDRESS: STREET clf j /z/O f j{ sr, <br /> CITY <) ra_ LP\O STATE 6✓& ZIP TEb 3 q <br /> CONTRACTOR PHONE: el ac,, ( qgo CONTRACTOR EMAIL: jet <br /> co fl t '14)er-bi>is®11017 /(-,(A <br /> CONTRACTOR LICENSE#(REQUIRED):►CD 1?So 3(USC3& CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): S(2Q h <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> Son 1-Z0V) <br /> I)SC.)N CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 37)6 OQ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New ❑Addition El Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:,-- <br /> e Ft.‘..c,6-- ` '1-1\esu©rc `T -r t x;v Zt OF Wc`bE <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 List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump "7 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub 3 Urinal <br /> Gas Piping Boiler 3 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 I No. of Heads • <br /> ACKNOWLEDGEMENT:I have revie .-. his 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 . - law. - .anting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official b- •e b. • - thori -. der 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 /> .-.I comply wi, th-S: - • trac• aw 18.27 RCW and 296.200A WAC. <br /> 1 <br /> City of Everett Official Use Only <br /> PERMIT# <br /> .. _ , ..A . ; 17l$Oq-00Z <br /> Ow - •uth,,r rrnent ignatIMP.— Date (Revised 9/23/2016) -F.&✓ f Seri.- <br /> frith -e> re,gcd <br />