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PERMIT APPLICATION ii <br /> ,174:/;--.1,414wiBUILDING ECHANICAL I PLUMBING I SIGN I UI INKLER/ 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: 42-1 j'Z, " S r PROPERTY TAX#: 2 C10 S-1700103 201) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: EVz>2CrT 1-\-Oi2 ) J(:, 114 , TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ti(0`] Col Va.... PZ <br /> CrrY .vg- G if STATE e N • <br /> ZIP � n <br /> �) <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: T-g 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: RIOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (ZS- 2,5-3 - SI, ) 'Mer 01.11) <br /> 4s-4-s;.D5 k „ ,— CONTACT EMAIL: c- .f-GQ y k Q e_v v,,It), , d <br /> BUILDING PERMIT APPLICATION \,f <br /> ExistingUse of Building: .1/ 2 OU <br /> ,f�-'�-on tri' "}S Contract Price of Work:$ <br /> Proposed Use of Building: S0'.1-rvi€ Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex QMulti-Family-1#of Units: q El Commercial ❑Industrial <br /> Type of Project: El New DAddition El Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> r - ,0-....... Y .ryb J✓T'l- 1 o y.s .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 /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #°f 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 /> .......\E t ��— , ) - PERMIT# ?n 0 i. <br /> iv <br /> - o61, <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> r <br />