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PERMIT APPLICATION <br /> /111.,,,A0*/—... BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> 'AV CITY OF EVERETT PERMIT SERVICES <br /> ilif g 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 7157.2. CiziC.6 // PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:/ 4 fG JC./j12/...--107,1-7.-1TENANT NAME(If Commercial): <br /> OWNER/ MAILING ADDRESS: STREET /2... 3J 3 `,,, , "JIM i4jL.T�� 46:24.4- 4 . <br /> / /] <br /> , r�//../e — cITY -, STATE `j(� ZIP 9:.G,iy <br /> OWNER PHONE: 442_,5-- <br /> c2S-'o2,-22::,64, OWNER EMAIL: (A)g6"'�i' J /.Z2.3 G c IeM 'T',UE"— <br /> CONTRACTOR NAME: 49w4:Xlie-/‹.._ <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: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: G, '=.,2-6-a a`:(t‘.. <br /> /¢w( . (,,,Ae: CONTACT EMAIL: lit,e-Gt-o'rlelty✓./2236Yenget447.,t , <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 6 ,4ez, Contract Price of Work:$ /6©v� <br /> �� <br /> Proposed Use of Building: Heat Source: OGas DElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel ,(,Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use __ <br /> DESCRIPTION OF WORK: <br /> ,r-Roe, .--- (LI > p(Akel'a� to/as,4 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): e l U <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 1 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 /> Ai' 770a0Je-- PERMIT# <br /> '�- 61( SSD7 -MS <br /> Owner/Aut orized Agent Signature Date (Revised 9/23/2016) <br />