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PEF"MIT APPL@CATIOI_ <br /> BUILD1111 I MECH .MAL/ PLUM i=.8NG I SIGN —RV.KLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> • 4677. 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 /> (Flue or Black Ink Only Please) PROJECT SITE HNF©RM/ATIIO . <br /> PROJECT SITE ADDRESS: 3pG// � y% er PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> 1C•NTrvCT Hi,'lFORMATHli <br /> N <br /> � '1 <br /> OWNER NAME: 0_ TENANT NAME(If Commercial): y4c,/°C<�C."--- <br /> OWNER MAILING ADDRESS: STREET/070K 4/1.1-14-A-al <br /> �` /�A 2 7 <br /> CIN 07/4, STATE �� //C ZIP : <br /> OWNER PHONE: OWNER EMAIL: ` V <br /> CONTRACTOR NAME: ._ / C.G- 0 ()Mil-) <br /> CONTRACTOR ADDRESS: STREET , /7 ��/� <br /> Girt �j"3* aATE (� ZIP <br /> CONTRACTOR PHONE: /02 /...f—q/ 2 CONTRACTOR EMAI �ir".rri �6,�G /GG!�/ .L <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER firONTRACTOR 0 OTHER(Please Specify) -�,/ <br /> CONT ME: CONTACT PHONE: r r-0.072/ <br /> v CONTACT EMAIL: r %2'/ /( 7 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: (fii>.044 / –1 Contract Price of Work:$ ‘-‘71--, <br /> Proposed Use of Building:‘(..4/ekljs, • Heat Source: (1Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ONew DAddition ❑Remodel DRepair DT.I. ❑Sign DSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: , ----,,,,, <br /> /4- /JUG rall6- are- <br /> ASSOCIATED .5y.x7e74,1- <br /> BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION f <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 /> 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 /> I 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 of Everett Official Use Only <br /> e/ / ' PERMIT# 11 0c) <br /> authorized Agent Signature Date (Revised 9/23/2016) <br /> Er----.1) <br />