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II II ''IIII PERMIT APPLICATION II II <br /> BUILDINdIMECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> �M 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 /> (Blase or Black Ink Only Please) PROJECT SITE INFORMATION // <br /> PROJECT SITE ADDRESS: 2-(Z `7 6 fil 9 fid C 1(9l, l tom- 907433 PROPERTY TAX#: (0 7/9 ooOa)S <br /> LEGAL for new construction: Short Plat/subdivision 2( <br /> Q �F Lot No. (attach copy of long legal description) <br /> CONTACT 1 ORMATION <br /> OWNER NAME: I/VI ( ...c. . At a...1-e- p TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET P aI)c 7 �j �7 <br /> CITY ( /0/Ah) t( ///lam STATE ZIP (�0 7 L-► <br /> OWNER PHONE: Z7 t ®Z', 6 7/3 'OWNER EMAIL: <br /> CONTRACTOR NAME: 01( /Z4€ tidw tt 6 <br /> CONTRACTOR ADDRESS: (J STREET ®e 0,nig be. 203 r �r/� <br /> CITY 4 ( 4'J VJ(GC'�fMr-Of STATE /� ZIP 7 C1 07� <br /> CONTRACTOR PHONE: (C.f 21": 89 1) 7(� / (� CONTRACTOR EMAIL: (G(0'Cie44'f o,i es II G Q'l�l4j'plate <br /> CONTRACTOR LICENSE#(REQUIRED): 001Cr L&tI .V 71m) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)' <br /> PRIMARY CONTACT: Of-OWNER 0 CONTRACTOR 0 OTHER(Please Specify) C19 O' 1 15. 5()I� <br /> CONTACT NAME: CONTACT PHONE: L{7y-, 921, o I7<3 <br /> t (,c f VIA CONTACT EMAIL: 16j�(GIra eho.'i -rife;. ,/SO//,C <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: S Wirtz" % .1'lk ( yContract Price of Work:$ cc 000 <br /> r <br /> Proposed Use of Building: S-'/r./��( P41N1 ( G`) Heat Source: OGas IZElectric DOther <br /> Building Type: /SFR-Detached SFR-Attached ❑Duplex ❑Multi-Family #of Units: DCommercial ❑Industrial <br /> Type of Project: ❑New DAddition ..Remodel I,arcepair DT.I. DSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: � � <br /> 1� LI /06_LI /06_6059r-G- Gcoftf---IiV(s/f.4 <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 #°f List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump 2 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 3' Lavatory(Wash Basin) Drinking Fountain <br /> 11, 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 j Water Heater Other: <br /> 7 Exhaust Fan I Sink(Service/Bar/Mop/etc.) Other: <br /> _.. C.4-0(1 OILY <br /> SPRINKLER/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. thorized 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 I tractors Law 18.27 RCW and 296.200A WAC. <br /> `Cityofof Everett Official Use' Only� <br /> , 3/ce P7s, i <br /> •yner/Authorized Agent Signature ate (Revised 9/23/2016) <br />