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"ffrAdi.„--aPERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: t 1 1 1 1 2 54- eerfi WS zoS, PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ,�!! CONTACT INFORMATION <br /> OWNER NAME: �Qb,iha( �Ol• &N[Iaid- t.Oc mai,TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /6.7'2 t I yvet- iy tai ao <br /> / J <br /> CITY t co f A.,,,„,) 4STATE �_A ZIP gg.J <br /> OWNER PHONE: ZSR ( ZZ- 6-6 OWNER EMAIL: 6121) �'hsC. 0/1 <br /> /// <br /> CONTRACTOR NAME: till eas`''''y v( ��I ij 1 J p,..`_ <br /> CONTRACTOR ADDRESS: STREET �./ a ( cc 7A)Lt. . <br /> CITY �^�)eke. STATE In/ / ZIP 4 ../ Z <br /> ' <br /> CONTRACTOR PHONE: �'�2.%3 - 3 3 t - 3 1 ( I CONTRACTOR EMAIL: f)')i�f ci, S ED W yC(�( I 1 'C d, LOY% <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRE R : <br /> PRIMARY CONTACT: 0 OWNER (CONTRACTOR 0 OTHER(Please Specify) 0 3 7 <br /> CONTACT/ � NNAME:�' �! CONTACT PHONE: it ZS - 3 z g- s /a ct r <br /> /"VI/1 4. �l�W•e/yZI��D� CONTACT EMAIL:/) �f5 €+ w,�eG/G,N UQe"10, CO lte <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: HO Li S e Contract Price of Work: ° dr 19 • - '.- <br /> Proposed Use of Building: Heat Source: ❑Gas ' ❑Electric ❑Ot - <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: i-ommercial El Industrial <br /> Type of Project: El New ❑Addition ❑Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: R <br /> Detwo/i t cam, a j -e,X-t S't'" to.s -\ <br /> c 0) `4 arlf--- <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/SUPPRESSION SYSTEM <br /> Chemical or Water I No. of Heads <br /> ACKNOWLEDGEMENT:l 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.n City of Everett Official Use Only <br /> ( /1-004/04e417- <br /> /"✓ �_ `1Z[>7 ) ( 7 PERF —000 (""� <br /> ��iV�V�ra,�l(��� �S"44-,04/thorized Agent Signature �'l Date (Revised 9/23/2016) <br />