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047-1- PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN /SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 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 /Z <br /> PROJECT SITE ADDRESS:LI U 3o Pi 5L PROPERTY TAX#: 0) 1 CO ( zj 60 bo'I t,)'(, <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1(Y a,4-4,_,.,,,, DJ,. {. O T TENANT NAME(If Commercial): <br /> "9 <br /> OWNER MAILING ADDRESS: STREET L(V 3Q" 1)-r 3L <br /> CITY A)--424\-&'--4- STATE kik ZIP (/)805 <br /> OWNER PHONE: ( ice) B32 _ 7-(3( OWNER EMAIL: (,()j 1 S 3I Y1@,1 gni Q,r (,(Oil <br /> CONTRACTOR NAME: <IA '') 14e 0-4-)V7 1 ('&C- (J� <br /> CONTRACTOR ADDRESS: STREET J (Q 1, ") c f( 'f� Sit s L& S v i 1-/ L <br /> CITY Lij(1OIL)06 ci STATE Iii/ ZIP 986 (.,(2 <br /> CONTRACTOR PHONE:(40-c-) , --7.i----- - ('5'7) CONTRACTOR EMAIL: m Aft ail&P(J6,413 k ca, <br /> CONTRACTOR LICENSE#(REQUIRED): K!Mr=)51'y(byz-f,)/r CITY OF EVERETT BUSINESS LICENSE#( EQUIRED): eq 07-c- <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: ( 'n, 1 CONTACT PHONE: (Uv&) ' _ q8i,' <br /> - Ocn\ VUj✓�t l. I CONTACT EMAIL: 1p p✓` IV 6 kia'L. j Y_C_cjtr'. <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ L(L/co <br /> Proposed Use of Building: Heat Source: 2Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached NISFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WO K: <br /> \A <br /> ASSOCIATED ILDING 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 /> 1 NC—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 ' 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 loc. .,w.The.ranting 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 . horiz-. der a• cu.-ance.I am t : .wner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I o ply wi the St. - ,,ntra . aw : " , and •..20':,,WAC. <br /> City of Everett Official Use Only <br /> /.7 7- ,, 6 / /to PERM4T�#� (b06,-•6(i0 <br /> Owner/Authorized Agent Signati Date (Revised 9/23/2016) <br />