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4IETT PERMIT APPLICATION <br /> 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:'3Q03 \/J COS( I'l0 2.01 Evil 40-5,PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: tO ' 't rlG TENANT NAME(If Commercial): &)e,i <br /> OWNER MAILING ADDRESS: STREET )\ lJ---(=i. I \- (7f <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 4.territcuisoex Corn - <br /> CONTRACTOR ADDRESS: STREET 12 L\ ?AV( v hoe K) <br /> CITY ((�A1 STATE w A ZIP Q 32_ <br /> CONTRACTOR PHONE: ZO(p- <A,-q 0019 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): Rt(rnA CL 0Ø5 E j CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):' 1 2_ (r" <br /> PRIMARY CONTACT: ❑OWNER,,,,laCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ',U( - 9-IAC _ 9 Q'1 A <br /> 1W+16t( (A W CONTACT EMAIL: <br /> hExisting <br /> � BUILDING PERMIT APPLICATION <br /> Use of Building: Contract Price of Work:$ i) 1 OOO Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> roject: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> PTION OF WORK: <br /> �0(uska1 csf e Y p�01to ( 1 ) ? -p bt nZ- <br /> ATED 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 /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> 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 /> Clothes Dryer Hookups Other: f ii(Irllll Clothes Washer Medical Gas <br /> Range Hood J 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 WA C. <br /> �/ +City <br /> �oflEverett Official Use Only <br /> PERMIT <br /> Y#I I i' �/OCo'U-I p <br /> Owrized Agent Signatu Date (Revised 9/23/2016) <br />