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PERMIT APPLICATION <br /> BUILDING I MECHANICAL/ PLUMBING I SIGN/SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERE I I,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 ((E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION r rC\ , <br /> PROJECT SITE ADDRESS: t ) t COt C c r(a.t N' ` <br /> PROPERTY TAX#: 'i` 0 t 30 f ' <br /> f` 0O <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: W\ec \e\ TENANT NAME(If Commercial):�r <br /> OWNER MAILING ADDRESS: STREET6'52)l C 1\t- C(~X\ A c r may/ � <br /> CITY STATE: & ZIP 9 SI 2(V <br /> OWNER PHONE: tkl-S 2 C,4''" 4 ' OWNER EMAIL: LA'2' ,e CINaOU la.lt.... .01"r1/4 <br /> CONTRACTOR NAME: " ( VQ pV \e--.�+'1.'cl Ce„.1 <br /> , <br /> CONTRACTOR ADDRESS: STREET Lk scc, �(^S^\ s ' -G <br /> CITU )\ V'AdkO ..0 STATE Ob.. ZIP ci3(0 5 <br /> CONTRACTOR PHONE:2OLo -1U3S- t... 5 t CONTRACTOR EMAIL c'eese emeCt\ck1"isCQLr-C�C e <br /> CONTRACTOR LICENSE#(REQUIRED): (�U( t -- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):05'7 pita <br /> PRIMARY CONTACT: 0 OWNER *CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ pp 1 2t 00 O <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> Building Type:VSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project. ID New ❑Addition .Remodel ❑Repair OT.I. DSign ❑Sprinkler ©Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: \t'\ t it 3 S^ peI`f -}-A+t--- r�o_m_ 1. , ^ <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 #of <br /> List of Fixtures #of List of Fixtures #of List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(inside Bldg) <br /> 1 Forced Air Systems Unit Heater Bathtub Urinal <br /> 5 Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> 1 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/Mopfetc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Chemical or Water 1 No.of Heads <br /> ACKNOWLEDGEMENT:l 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 Were!,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!am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply ifh the State Contractors L. 98.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> / I� PE M #el/ i - ( çJ /(( ) <br /> Owner/A thorized Agent Signature Date (Revised 9/23/2016) <br />