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(4eivr PERMIT APPLICATION <br /> BUILDINL 1ECHANICAL / PLUMBING / SIGN i aiPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: )a.6,/ J y? (i5JtL, va<- V `j izz-AA PROPERTY TAX#: l,03(125n IOi J 64' <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: EMt<p L4l - f& 2 1 l_(_C TENANT NAME(If Commercial): r2a:---! �'71Q— <br /> OWNER MAILING ADDRESS: STREET ))A,3 z- J -Az 3-' l /� <br /> / CITY �h_(' STATE L/4iik ZIP 2�1� <br /> OWNERPHON('72) 252-- 0Cc)�jr OWNER EMAIL:am�I'i' �-�(GI-G)5 "nos( e' 11\ <br /> CONTRACTOR NAME:`(L�c <br /> d <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: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: Li CONTACT PHONE: ( )'LIZ - �,b7 <br /> Sti1U r 1 ‘•-'(e_ <br /> CONTACT EMAIL: ,,,.,.,a r,A.�• p/��J.,„_e r f nv\ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: iGrcltn Contract Price of Work: $ 3 :,. vt✓cT <br /> Proposed Use of Building: C�--C�.-.K. 5 k c Heat Source: OGas QElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Mufti-Family-#of Units: 2jCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition )Remodel ❑Repair CIT.!. ❑Sign ❑Sprinkler glDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> k Ive..5(c5 (_bc�—r. ek <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 #of List of Fixtures #of List of Fixtures <br /> 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 /> / / PERMIT# c. i ; !� <br /> Owner/Author'-Agent Signature late (Revised 9/23/2016) <br />