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PERMIT APPLICATIO+ <br /> /1111P014%/V=a <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN/SPRINKLER/ DEMOLITION <br /> 40111W1CITY 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: 0.6 I D .2,64Nc4 o( PROPERTY TAX#: <br /> ' LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: r'�-(`.¢? Ark S ,Sgse r TENANT NAME(If Commercial):� SQ �.Q. 4/1 , f <br /> OWNER MAILING ADDRESS: STREET /6-7,F;21_0 6/s---6/s---/A--- -1 g i �` <br /> C_ <br /> CITY oace..'"�v Pw AI`c____ STATE (-) ZIP 7q 9Sls <br /> OWNER PHONE:‹,Z 66: 3a... f C2 7 9 OWNER EMAIL:J re q scl r'De r,ti 9 tc�) 1,84,--6,:i ). c O,.., <br /> CONTRACTOR NAME: ea- W ( <br /> CONTRACTOR ADDRESS: r STREET , { II/ r - . .. , . <br /> Crw -ti c.?rl�J STATE 73 7 / <br /> CONTRACTOR PHONE: / ^, 37 7- 3-971/4)----CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIR' . : • % — i CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ®OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 5'1..6 i�.- ,t,i/ to Contract Price of Work:$ Z.oat!" <br /> Proposed Use o,ffBuilding: (` Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: USER-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel C epair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> /3 r-, V Q./l.-1-,I l Oat l d C-- <br /> t-� CLO- r t )25 <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 Kitchen Sink&Disposal Grease Trap <br /> Gas Range (..--'Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> L/-,.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 comps with the State Contractors Law 18.27 RCW and 296.200A WAC. . <br /> ' City of Everett Official Use Only <br /> R IT I/0 I: <br /> ) 2 <br /> NM <br /> ��D' O0 <br /> Ownr/Aut,.rized Agent Signature Date (Revised 9/23/2016) <br />