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PERMIT APPLICATION■ <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> ���°:4/--- CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I 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: \Eg\y 1 ZT� S-k-S8, 2,0o C10 PROPERTY TAX#: <br /> LEGAL for new construction: Short j Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 0,�p 1 ery-e q cz—t` TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3 g ,a S. ? U,LV h S-_ <br /> CITY A Vb 0 cf..) STATE 1A\J ZIP G ,g-6-5,-, l <br /> OWNER PHONE: ' .g.'3 —L,�L_/4-1 1 le, OWNER EMAIL: 1�lrx y l�t Q nc31 Wl� \` t, x-)lin <br /> l <br /> CONTRACTOR NAME: 'Jht✓ 0 f.. <br /> -e, -2� QA <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE l_ ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: bwkjle 1-Z Q Vj&,/►OZ , COM <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE�J#(REQUIRED): <br /> PRIMARY CONTACT:%OWNER 0 CONTRACTOR 0 OTHER(Please Specify) Cda f (Zr`/Le_p-- D .A; <br /> CONTACT NAME: CONTACT PHONE: 2 5.3 Fc 4f 7[C <br /> "tv , l e? CONTACT EMAIL: )e 76 C' 'C' 9 C <br /> /` BUILDING PERMIT APPLICATION ft446,7'44 ie '�,2 g <br /> Existing Use of Building: 3t4 yle_ 6n, 9 Contract Price of Work:$ , � ' <br /> J_r�" O <br /> Proposed Use of Building: (/ 5 reek ` Heat Source: ❑Gas Ifnectric ❑Other <br /> Building Type: ❑SFR-Detached FSFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: DNew ❑Addition ❑Remodel `pair DTA. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIP ION OF WORK: r 1 S c.� (e �a,( Or el - l <br /> v..?e to c-6, I-0(4-e c7 S r?"7 4z 1.1,05e&ii-e_ ..c roors 4 el----t-i-- <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 #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 1 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.lam the owner,or lam 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 /> 1 City of Everett Official Use Only <br /> PERMIT# <br /> (` ALU C ( V -OO( <br /> Own uthorized Agent Si nature Date (Revised 9/23/2016) > 1)\ <br />