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IIII PERMIT APPLICATIOI^ <br /> DUILDINIIU 1 MECHANICAL, PLUMBING /SIGN ,SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> iliOerr 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I 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: 12 sou eaal f,,/to,J,,y PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:/ft(, /10.,# Jlwt) L.& C TENANT NAME(If Commercial): Y)/14// , Pit,�'.��< 1 <br /> OWNER MAILING ADDRESS: STREET 1��S2&I t) f' /Lc qc 1c.!`•JJ ,edyl C��j.� r� <br /> CITY S pt,I(.(1Q„J STATE 1,44 ZIP /O.<-r <br /> OWNER PHONE: qzs-30'- CJs?2 OWNER EMAIL: obi AµC 5vol c(Q gtyl.A4`t_.&L4-1 <br /> CONTRACTOR NAME: (7LL1 / 17,Aj ,1/4_, <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: 2o,-Q4 G--7:3) CONTRACTOR EMAIL: 5Th it€444/lug, %ifir=C'd.� <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICE SIVE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ld..QTHER(Please Specify) 7? t1 Jt -t <br /> CONTACT NAME: / CONTACT PHONE: 2610 , 3 ,. --?•t,/3 <br /> -3 ( ✓vi i(ftrtk/ CONTACT EMAIL: L',yl 0 jinn//o€ f;��ecj,, <br /> I! BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 1etfi.L Contract Price of Work:$ .7 .3 60-0 0 <br /> Proposed Use of Building: RcTti t ph.;AAJT 37z.,a L Heat Source: ❑Gas 0Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family#of Units: ,t ;ommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair AT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: N6T4 it ti.p`d6tiPM) iii <br /> e1O;"-117 <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 I SUPPRESSION SYSTEM <br /> Chemical or Water I 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 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 /> #*9 PERMITr#k tc6O H 02H <br /> er/Authorized Agent S' n re Date (Revised 9/23/2016) <br /> 1/ <br />