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PERMIT APPLICATIOt ��I <br /> BUILDINUHIIECHANICAL I PLUM.:ING I SIGN J INKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 l(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or =Mack Ink <br /> Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ((Z.Z - iV PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: MA-FLA (y3 pe}Z,,F-E TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 6.2-Z 1) ,e6Sr' 114ZW..- <br /> CITY y�l STATE t34 ZIP 98E63 <br /> OWNER PHONE: OWNER EMAIL: <br /> • <br /> CONTRACTOR NAME: 1i1/4l\SMA 1UAkFa-T 51S-11,1/ <br /> CONTRACTOR ADDRESS: STREET / J b2,, 562t-t' t S(9( le 1 D) <br /> CITY LL-1 Ai 1i 1A)(230A STATE /A)14-- ZIP Cf j0 <br /> �/ 3 C(� <br /> r\ <br /> CONTRACTOR PHONE: !2J` pt _Z5ZG ' <br /> j CONTRACTOR EMAIL: , C� re, 11 / j,� '- , c <br /> CONTRACTOR LICENSE#(REQUIRED): jr•JJbVS 895 CIM CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): S7,5&9 <br /> PRIMARY CONTACT: 0 OWNER Og CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: "341 "Z.. Zlo <br /> INA PiN Da 5 CONTACT EMAIL: (\GklAe it J-A cevAA <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ /ea) <br /> Proposed Use of Building: Heat Source: ❑Gas Electric DOther <br /> Building Type: , SFR-Detached @SFR-Attached @Duplex @Multi-Family-#of Units: @Commercial @Industrial <br /> Type of Project: @New @Addition @Remodel klRepair DT.I. DSign @Sprinkler ❑Demolition @Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> • <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 # 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 /> T 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 No. of Heads • <br /> ACKNOWLEDGEMENT.-t 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 authorize.under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State ontractor Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> /f— /946 kagu-biq <br /> Ow er/Authoriz d lent•ignature Date (Revised 9/23/2016) <br />