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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 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION - <br /> PROJECT SITE ADDRESS: 512 944 1 -1--.. ..11) PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: D1/IC.1.. --i- L—1 ylatk V f1IAV1 t TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5 I Z A(-1-1-11 S-f. S to <br /> CITY e V ef-E- - STATE 10T" ZIP -(B ZOLt <br /> OWNER PHONE: OWNER EMAIL: V C Ode.1 cYY1GU l , COW) <br /> CONTRACTOR NAME: 'P1 I Ch(ACID I E44-i t' <br /> CONTRACTOR ADDRESS: STREET 1429 ik--l/ ._. 4: 22-`4 <br /> CITY SVIOhtem ISYl STATE WA-`# ZIP 6182.6o <br /> CONTRACTOR PHONE: I 2.S -j 435 -©lpSc1 CONTRACTOR EMAIL:?1\C UUCJLTI Estn3()P1 kvwc . -4- �_ ,Yr) <br /> CONTRACTOR LICENSE#(REQUIRED): ?SLC f 1(47 Q7 ?La CITY OF EVERETT BUSINESS LICENSE#(RE 0• -ED`r, ,� <br /> PRIMARY CONTACT: 'lg OWNER 0 CONTRACTOR 0 OTHER(Please Specify) �.._,e, �,_�' <br /> CONTACT NAME: CONTACT PHONE: 4 -SO(- £.4 <br /> T —Fad VV CONTACT EMAIL: TE. 'r r 1\ •- i6L-t-trY .Cbw <br /> BUILDING PERMIT APPLICATION <br /> " Existing Use of Building: Contract Price of Work:$ 4�—7 SOO' <br /> Proposed Use of Building: Heat Source: CgGas ❑Electric P•they <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ■Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. CI Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> L'ISA-Cd jAs OtpI , inet,6maCe _ hevJ dvdrt.)30 +0 axIS-VIn() \-\0111C... <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 #of #of <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtuye� Fixtures Fixtures Fixtures <br /> r Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> ( NC <br /> Forcd Air Systems Unit Heater Bathtub Urinal <br /> Ga Piping �'8er Lavatory(Wash Basin) Drinking Fountain <br /> W ter Heater Ref igeration Shower Floor Drain <br /> as Fireplace W od Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range cting 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.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 /> !� l'7 ! ? PERMIT �, 0 _O,lO <br /> (Revised 9/23/2016) <br /> Owner/Authorize a Signature ate � <br />