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PERMIT APPLICATIOI— <br /> BUILDING /MECHANICAL/PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OLT 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: l a 11 E4�fi /lA.,e,piR t//.€4'ci IV- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 'F----:r4 A ri/S .fit - TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET - �/`�` 6, 03 ii./ .J � <br /> / G( 7 �� 0 <br /> �-P>�. CITY G STATE ZIP 7 J 7 <br /> OWNER PHONE: 2 b 4, - 7 �j�'" C) 17 OWNER EMAIL: FNl xi e c..), �OL� 4 UV <br /> CONTRACTOR NAME: 0 ii, h.,e,,. ex <br /> </ <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT:,WNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ' (e c/& 7 er,44 Contract Price of Work:$ 470 00 <br /> Proposed Use of Building: S 4 Ai ,0 Heat Source: ❑Gas EpElectric ❑Other <br /> Building Type: p36 ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition emodel piiVepair ❑T.I ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: [a,,, v t a_Z ) yt � j/�,.c. 11 ; p h g-4-e--7.5 ,roi o .Q RA-teller-4 <br /> 5-eCt-vr- 1"R/t5e< �), (f6�'L4Y`$�la,-e 11 o0GI Onr^h " Abarc{-6_, iAanyrk' d(o.-LC <br /> Ip ✓ "4j� ✓ , `e <br /> AS CIATED BUIL PER #(iapplica ): �� <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 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 /> 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 /> Q� I <br /> �_ e.--...._ <br /> PERMIT <br /> 01 PERMIT W ( �O� ". <br /> Ovine •u orize. •.ent'ignat re / Date (Revised 9/23/2016) <br />