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471Err PERMIT APPLICATION <br /> BUILDING /MECHANICAL/PLUMBING /SIGN / SPRINKLER / DEMOLITION <br /> CITY OARSEVERETT PERMIT <br /> RVICES ORIGINAL <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 j(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2� t6 l�( '171 3' r 1 PROPERTY TAX#:CO,1 3 b bow l7/ <br /> LEGAL for new construction: Short Plat/subdivision f I (�(/ Lot No. ( (_JU(a`ttach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: I�t / 6--\-f1n Wir,e, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: ' STREET 'Z 9,& 5-75441'� i 1 � ) / , I /n� <br /> CITY EVy l(1I/ lJ 6 STATE' /1 ZIP '1/ zo- . <br /> OWNER PHONE: �&' (/j- j"l 17 OWNER EMAIL: ����(E �a lll�� <br /> / L jymiCONTRACTOR NAME: ,{�� (O/ / <br /> CONTRACTOR ADDRESS: STREET -lilt /74411 ( ) I <br /> CITY VVVV / / qV0i:e ST TE / <br /> ZIP 6/0011y <br /> CONTRACTOR PHONE: /7_ : - 6 CONTRACTOR EMAIL: In * ta <br /> CONTRACTOR LICENSE#(REQUIRED) <br /> LU 7F3 T 174 a CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):05- q6 <br /> PRIMARY CONTACT: 0 OWNER .CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Li,, .P)- � - f �t� /�, <br /> Wa nnah kAoeno� CONTACT EMAIL: �� /'phi h�������IO��I�YI f �� l <br /> J V BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ � ,1 V <br /> Proposed Use of Building: Heat Source: ❑Gas .Zflectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached 0 Duplex 0 Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> A/C <br /> C)(0OJ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration XRepair Type of Project: _New _Addn Alteration _Repair <br /> #of #°f List of Fixtures List of Fixtures #°f 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 /> - <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 /> Number'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.lam 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 /> D / City of Everett Official Use Only <br /> a g <br /> PERMIt O3 ` 0( t--4._ <br /> n r/ ap,e Signature Date (Revised 10/12/2015) r <br />