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PERMIT APPLICATION <br /> 0:Err BUILDING / MECHANICAL/PLUMBING I SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> P)425-257-8810 i FAX 425-257-8357 i(E)everetteps@everettwa.gov( www.everettwa.gev/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2 22 1 pL 5e <br /> LEGAL For new construction: Short Plat'subdiviion PROPERTY TAX#: <br /> ----.-_—. _, Lut No._ (attach copy of long legal description) <br /> CONTACT,INFORMATION <br /> OWNER NAME: • • fAty - <br /> TENANT NAME Itf Commercial): <br /> OWNER MAILING ADDRESS: sTPEE- g2« - I. L <br /> SE <br /> carr <br /> STATEVlJ' ` Z1P S20 <br /> OWNER PHONE: „! 1 <br /> 1 OWNER EMAIL: <br /> CONTRACTOR NAME: - . r <br /> CONTRACTOR ADDRESS: 1`S" 06-du-0 b;.h, 0 <br /> TIPPET �t,. <br /> CITY i I , fi,. ... <br /> STATE A.. A-- ZIP ir i. • I <br /> CONTRACTOR PHONE: L '�'?C3C:t <br /> 5Q CONTRACTOR EMAIL-L. ,4 ', ' no t CO <br /> CONTRACTOR LICENSE#(RFQUlREDIz 4.:► - _a* *., ciTY OF EVERETT BUSINESS LICENSE#REQ <br /> PRIMARY CONTACT: 0 OWNER k f tilREa): <br /> t,Or�?RACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> J t CONTACT PHONE: 1..,_26 259 0 "1t✓Toa5-r <br /> , <br /> CONTACT EMAIL: 0 a a a • 1 ^� ' +Co <br /> BUILDING PERMIT APPLICATION ' " �� <br /> Existin« Use of Building: <br /> Contract Price of Work: <br /> t ro.osed Use of Buildio <br /> .__... e . <br /> Heat Source: ❑Gas tk!Electric ❑Other <br /> BB it inf Project: ❑New ❑Aedition SFR-Attached ❑Du lex <br /> Building Type: ;SFR-Detached Q <br /> p Qlttt3-Fatuity-#of Units: ❑Commercial El Industrial <br /> ❑Remodel ORe�nair �" — <br /> DESCRtPTION OF WORK: ion OT I. Osign OStrrinkier ODernolition ©ChOni e of Use <br /> C"5±a. <br /> Q�i fit' PU <br /> Pile <br /> ASSOCIATED BUILDING PERMIT#(if applicable:): <br /> NtEH4t+lICAi. PERMIT APPLICATION <br /> Type of Project: Naw Addn Alteration Repair Type of Project: New Addn Alteration <br /> A[ <br /> PLUMBING PERMIT.APPL <br /> #of #ofIteration Repair <br /> Fixtures- LisC�tP.FiJtGUres _...... List #of <br /> Ftk4 t lsa of Fixtures _ _, #of <br /> A/C–Air Handling Units Fixtures — Gfsf of Frxitrres <br /> Heal Pump <br /> Fizfctres <br /> Forced Air SystemsToilet Backflow Prevc Hier(Inside Bldg) <br /> allellUni! Heater Bathtub <br /> Gas Piping Urinal <br /> �� Lavatory(Wash Basin) Drinking Fountain <br /> 11111Mmil�Refrigeration Shower <br /> Gas Fireplace, FloorStove Floor Drain ammo <br /> Kitchen Sink& Dis osai Grease Trap <br /> CaralEIMIN Clothes Dryer Hookups 11.11111111111111 Other; <br /> UM Ducling Dishwasher <br /> ME Clothes Washer Mediofcal <br /> Drains <br /> Ran we Hood Medical Gas <br /> �{�` Water Heater Cather: <br /> Sink{Servtco/B rtivtopJete.) Other: <br /> IIIIIIIINIMN <br /> SPRINKLER'/SUPPRESSION SYSTEM <br /> Chemical or Water No,of Heads <br /> ACKNOWLEDGEMENT':1 have reviewed!his application and confirm the information salaamed harem is true and correct. Work done pursuant to this permit must Comply. <br /> retreat iederat,stata.and local law The granting of a pc+rrktit only authorizes approved work end no deviations lherefmar.Deviations must first be aultvnrized in wetting Porn the <br /> Building 0/flora/before being authorized under any eirounl,Wohce.I am the ownerer i am authorized by the owner of this property to perform the work for which With <br /> and I romnty wan the state Connectors Law ia.27 faCWard 296.200A WAC. <br /> aa'.'pircatlnrr!a mode. <br /> City of Evereif Official Use Qnty <br /> PERM! # <br /> Ow,or/Authorized Age• .*•re "# 15.1 V t Il 'V <br /> 9 Signature (J J <br /> rDate <br /> (Revised 9/2312016) <br />