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I PERMIT APPLICATIO I'iI <br /> BUILDINt/ MECHANICAL/ PLUMBING /SIGNIPRINKLER/ DEMOLITION <br /> ./ � CITY OF EVERETT PERMIT SERVICES <br /> +r 0 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: "7/I AM/19-SE Evert*- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:3-01-n F.y' ly//��L,u V��, <br /> TENANT NAME(If Commercial): vf- <br /> OWNER MAILING ADDRESS: STREET b`%o, &i ca.‹...? D�j <br /> CITY .t/e 1/1/A_1/1/A_ STATE 1A/,//- ZIP /67447 <br /> OWNER PHONE:4 g 8.44,7a OWNER EMAIL: 3C.f'70 c3 ft C 44 <br /> CONTRACTOR NAME: S' n2 !n' <br /> CONTRACTOR ADDRESS: STREET //(p/l ,Baez /427 <br /> CITYi fl+ liarA PA STATE 44- ZIP9f2 7„3 <br /> CONTRACTOR PHONE:(3(oa) ca�_ /635— t IICONTRACTOR AIL: ok. cC4-0 <br /> CONTRACTOR LICENSE#(REQUIRE 1 -S` (5V F ) ITY OF EVERETT BUSINESS LICENSE#(REQUIRED): r------->A <br /> PRIMARY CONTACT: VI-OWNER CONTRACTOR ❑OTHER(Please Specify) (\ .4,i . l..t:CC•i.►��1- <br /> CONTACT NAME:"' CONTACT PHONE: (:36,6)162t/-/5 _..---=:-/--1:-'1 <br /> c`rn Sjie CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building:f,Jef€JMU)2) .NIGtnUf�i.e tei. , ,lpjjieContract Price of Work:$ /0'201/200.090 <br /> Proposed Use of Building: ' ,D Heat Source: ❑Gas DElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: DCommercial El Industrial <br /> Type of Project: ❑New DAddition DRemodel El Repair DT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Re n 0 St�_J�C 6 J(f /I_ a / j -61. )dee "th <br /> i' /3 JJ vn <br /> IJ JP*Y1 COO 129, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration -•.air Type of Project: New _Addn _Alteration /Repair <br /> #of List of Fixtures #of st of Fixtures #of List of Fixtures #of ist of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet B flow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub rinal <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 •okups Other: Clothes Washer Medical Gas <br /> Range Hoo• Water Heater Other: <br /> Exhaust F-n Sink(Servi ar/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 /> 3/ism//8 PE.�1`W •-02-5 <br /> c , ,- •uth+rized Agent Signature Date (Revised 9/23/2016) <br />