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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 J 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: f x-12. II" S`af '_V46_T i— PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT/ INFORMATION <br /> ` <br /> OWNER NAME: I9 Sie-t`rn met j //tt/IV _ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1c(D(b col Avr THE 4k-i___ <br /> CITY L1t44 -tat i STATE w ZIP 98223 <br /> OWNER PHONE: '-2S- 2(r -3 t (9--- OWNER EMAIL: ' R. .( (4g) 0011'SDJ c tbtlOWte.p1Zt,S,c.owN <br /> CONTRACTOR NAME: jieAlgly►S SV.tTt11J0 <br /> CONTRACTOR ADDRESS: STREET r(D 1 D (Q( ,A,1�z__ 14 _ 14... �y n <br /> 2 <br /> CITY Lt AJJ4 t`D (STATE (,Jr ZIP !e.2 3 <br /> CONTRACTOR PHONE: 1a2.s'r2 r 3 t 1- -- CONTRACTOR EMAIL: ' ?-1,1^-fsa f ¢ 7µ ONt)`ADO pas.c.-`- , <br /> CONTRACTOR LICENSE#(REQUIRED):40)2114144.9 /4'4-- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED); P * <br /> PRIMARY CONTACT: KOWNER 0 CONTRACTOR - 0 OTHER(Please Specify) /00311 <br /> CONTACT NAME: CONTACT PHONE: ti2S'-Z - t(1 - <br /> '6g..4 rrrt.wey CONTACT EMAIL: galQ 4Iti i`jv14-p ftikteps LotAlk <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Y. -St HCl-drl__ Contract Price of Work:$ /50,000 <br /> Proposed Use of Building: 214 cbidv tom- Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: P7 FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition (remodel ❑Repair ❑T.I. ❑Sign DSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTI N OF WORK: <br /> -(N GY(o r ctN oU G, (tx-�j <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 .air <br /> #of List of Fixtures #°f List of> ures #°{ List of Fixtures #°f L',of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures / <br /> NC-Air Handling UnitsH--: Pump" Toilet Back,;: Preventer(Inside Bldg) <br /> Forced Air Systems L/'"i� ,\Heater Bathtub al <br /> Gas Piping ( ( /' :.ilr Lavatory(Wash Basin) / i!rinking Fountain <br /> ir Water Heater , ' 4 Refrigeration Shower i f- 1 Lor Drain <br /> Gas Fireplace I i /q Wood Stove Kitchen Sink&Disposa I % x; rease Trap <br /> Gas Range ! Ducting Dishwasher , Roof Drains <br /> IF Clothes Dryer Ho I.• Other: Clothes Washer / �� Medical Gas <br /> Range Hood/ Water Heater /(' ' Other: <br /> Exhaust F..' Sink(Servic-••ar/M: etc.) Other: <br /> i <br /> SPR `KLER/SUPPRESSION SYSTEM i'. <br /> • hemical 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 18.27 RCW and 296.200A WAC. <br /> // / City of Everett Official Use Only <br /> PERMI # <br /> • , er/Authorized Agent Signature Date (Revised 9/23/2016) <br /> (i <br /> Z <br />