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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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: /f(,f/ kro-pc94 /, 65 /07 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision t of No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: d 4 f Va t--I CY,, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ('`(y// Af - ,--t- `� ',�'p /07 <br /> lv (Z. i V-A STATE , ZIP 47.,_27. ..;,," <br /> OWNER PHONE: 219(. 2-245-7-/ -I/ OWNER EMAIL:/1lA6t h4/ Va p[' AI. ,40,..., <br /> CONTRACTOR NAME: S/GrjM <br /> CONTRACTOR ADDRESS: STREET 7// /NO S IL.. -V 5 k*"- --o •�, <br /> Ly AJ,1A/ �ITv2 Ct /./) G j 7 STATE 7 '/"� 1 !J C ZIP <br /> CONTRACTOR PHONE:/'p p cr 3 q 5o la/ CONTRACTOR EMAIL: 11 b t 11 t 1`/1 <br /> CONTRACTOR LICENSE#(REQUIRED): 614‘.1 If 01-7N1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNERCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: (9 ��/ Contract Price of Work:$ �[.7(7„ <br /> Dr) <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 ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 670 .5(e,,s © At guild, 0& <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 #°f List of Fixtures #°f List of Fixtures #°f 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 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 /> Buil.'• • ial before be' •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 /> a'.I compl with th-'.(,ate •ntractors Law 18.27 RCW and 296.200A WAC. <br /> / City of Everett Official Use Only <br /> // /I' c-0 v/r PERMIT# .. (`1 J l (f A0 1 <br /> Ow er .ut •rized Agent Signature Date (Revised 9/23/2 161 J) <br /> 0 <br />