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PERMIT APPLICATION <br /> BUILDING/ MECHANICAL I PLUMBING /SIGN / SPRINKLER/ DEMOLITION <br /> 41/11r6.°47-4 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.gav i www.everettwa.gov/permits <br /> (Blue or Black ink Only PNma s.) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 020%- /U 7`tik Pi._ Sc , V7-9m* PROPERTY TAX#:00 S to,g3tk MoD O <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: t)fiI/T'CA TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5Ril1 <br /> CITY STATE ZIP <br /> OWNER PHONE: 4/2,5-- (74%5- -0/1/ OWNER EMAIL: Pj M A/M/ earntedt.S`]". 4/& <br /> CONTRACTOR NAME: (og,J1/e s-7."(}/i/'6, RooFi/ av, Aim <br /> CONTRACTOR ADDRESS: STREET /7 40241 /5-12' 4 v'E /L4. SE #10/".? f r�y� r� <br /> CRY... f..+�- STATE Wet...... ZIP "f.eall <br /> CONTRACTOR PHONE:I/Q,S-48 --e)/// ,/�_ICONTRACTOR EMAIL: t$' YeedJ J ,T 1 ,pt9 '{} <br /> CONTRACTOR LiCENSE#(REOUIRED):COOL/0U 0 Z.1 ClW CITY OF EVERETT BUSINESS LICENSE tt{REQUIRE F3,56, <br /> ,56 <br /> PRIMARY CONTACT: 0 OWNER l.W ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:L?L 25-4$5-p/// <br /> NR, sTy flor F- CONTACT EMAIL: ,j jTV JIIF `rfh+ti fee ,,, - 69/-4 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 55/e Contract Price of Work:$ /S, ‘)'95•0.0.m.... <br /> Proposed Use of Bui ing: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Famtly-#of Units. _ ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel CIT.]. 0Sign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> kin vv eo-mP 81, /n 54Gid 1 P <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 #of List of Fixtures #of 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/SUPPRESSION SYSTEM <br /> Chemical or Water L 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 tam 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 /> 4100. 11,,,...., /41 PERi Fid# \'l J - "0\3 <br /> a' /Authorize,A!ant Sign Date (Revised 9x23/20 6) <br />