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PERMIT APPLICATION <br /> 0111PBUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> rF, CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 l 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: . Sr 5&) PROPERTY TAX#: 'fQy<?003070p© + <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Dqe PDX / The a/04e FOX 1-L.0 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5511 we 7'" PI• <br /> cnV ROY) foil STATE &IA ZIP ]8 059 <br /> OWNER PHONE: 1115 .- 3n8" 32 63. OWNER EMAIL: bike COI4rpIA'1b . Gomcaf,/-.4et1 <br /> CONTRACTOR NAME: 2 FL F r1 f erprl z es <br /> CONTRACTOR ADDRESS: STREET /0605 3 p2'1O* 51 Is 1301 <br /> CITY /Cen4 STATE WA ZIP gt03/ <br /> CONTRACTOR PHONE: g66 -A70 - 7127 r © CONTRACTOR EMAIL: I err t) 2-F-L. . Cal? <br /> CONTRACTOR LICENSE#(REQUIRED): 2 F L. j A/F 1 7 0 6£6 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) Pccj ecf /YIas1cc e_.," <br /> CONTACT NAME: CONTACT PHONE: 253- L186- 251 <br /> AAro f1 e 'er CONTACT EMAIL: t ef5;er4ol 0 oft-f-61:- CAM <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: fl j I4 t Awn,Iii �t Contract Price of Work:$ 1, 2Ov�~-- <br /> Proposed Use of Building: I Heat Source: ❑Gas ❑Electric Cl Other <br /> Building Type: OSFR-Detached ❑SFR Attached ❑Duplex ['Multi-Family#of Units: $ ['Commercial Olndustrial <br /> Type of Project: ['New DAddition ['Remodel ['Repair CIT.!. ['Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Rer>,ove and replace roof.ny . <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 #°f List of Fixtures #°f 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 /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Chemical or Water f INo.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein Is true and conect.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 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 /> 7 g.t/IYAIA' 3/013/11 PERMIT6 l 1.���• 5 J <br /> Owner/ Agent Signature Date (Revised 9/23/2016) V <br />