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I I PERMIT APPLICATION <br /> "P./.44,0"/---, BUILDINGTMECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: `i y/? i 4'r RacC,,V iv/1,y Eva;/j j,lii PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): t2. P <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Aty fkr 4,1,49,s2C Aq, C, • <br /> CONTRACTOR ADDRESS: STREET ,/%y,y/i li 77/ ym,,,2. t <br /> CITY iN' STATE 4/A ZIP 9,57(,17 <br /> CONTRACTOR PHONE: 2P6'-39 -gOZZ CONTRACTOR EMAIL:Ale 0,P,>/ce/&_.,,eE'),M�e,„„9 /2„„e• G®.n, <br /> CONTRACTOR LICENSE#(REQUIRED):,t-e)..h„�l v 4 2,'70,py z CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):f 7z 7 7 <br /> PRIMARY CONTACT: 0 OWNER 1XCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ZDV_ 3.9.6-To z z <br /> 1] /' CONTACT EMAIL: ,y n �,e <br /> 1'W a�'N�' L/I �cL _ �c�K AI�L�G.-.4 C' „„7✓rN z.ff A,fv'-e,41 _�/Jfl, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ /S Oyu <br /> Proposed Use of Building: • Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel ❑Repair DT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> IC <br /> DESCRIPTION OF WORK: t�i u.,E (2) o-<:�T.577 (' ,6, b../`y ,c,4SeS az3J „v.,j„1 •S45 . <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 3 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 1 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.l 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 /> PERMIT# <br /> ner/Authorized Agent Signature Date (Revised 9/23/2096) <br />