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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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3003 W. Det.:IVt n 1 'a . gvev. PROPERTY TAX#: _-(-i 3(tX <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: t2-)NrekA giinKQ/- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET C1(0 3L M1<A LL j ).Q L\ <br /> CITY Str�`M1.2 STATE LA ZIP l 1U3 <br /> OWNER PHONE: OWNER EMAIL: <br /> 1 <br /> CONTRACTOR NAME: rlG✓'(InVV'PSt 1111.E AS '- SctAUCf(A,P Cl/AV/1,0 inc_- <br /> CONTRACTOR ADDRESS: STREET 1(6L MO1e' E_ I: )t°_ 1•-1 <br /> CITY '3 e A4*`111 STATE WI,A— ZIP CI c‘lCI3 <br /> CONTRACTOR PHONE: 2_0(p 9 Z Cj-0Q,j y CONTRACTOR EMAIL: 1 la ., di A - 1_ iiiist;_,`" <br /> CONTRACTOR LICENSE#(REQUIRED): Kto g-TµWoo-15W CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 43 33 <br /> PRIMARY CONTACT: ".OWNER ❑ CONTRACTOR El OTHER(Please Specify) J <br /> CONTACT NAME: � n CONTACT PHONE: to Df _t �1 <br /> J1,ZtCk �i Yt�1c1 .N/ CONTACT EMAIL: n uu rnewSC'LYV ALT C O[y' cs E )' <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: , <br /> ft t Z Contract Price of Work:$ t('1` 7(, LI <br /> Proposed Use of Building: Heat Source: ❑GasElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: Cl New DAddition ❑Remodel ❑Repair ❑T.I. OSign ❑Sprinkler Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> D / - <br /> -2 Wt0114101n C DUUVjI,Q Vvirk-� 9 l.,r/kntll.C47 4 5 - <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 /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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 : 7 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> c. .3......„2 I! PERMI _ Oc <br /> Owner/Authorized Agent Signature D. - (Revised 9/23/2016) `� <br /> I� <br />