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'' IIII PERMIT APPLICATION <br /> BUILDING1 MECHANICAL/PLUMBING I <br /> SIGN hiSPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SiTE ADDRESS: P I. ) u- 4-, LA PROPERTY TAX#: OU GIL?e 8 0000 (e�e�r� <br /> LEGAL for new construction: Short Plat/subdivision Fol t'`‘‘.60)42,v\ YtY'S Lot NoThi?u (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: t*\CA.�/� St S K. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET / (� �/✓l er(? e j �j{ Ga <br /> ‹.-e_414411"4-.- <br /> y <br /> CITY �-e_414 STATE W Tt ZIP ? <br /> {Zy,„ <br /> OWNER PHONE: ' 7 -' 6' 30.- 3 OWNER EMAIL: r1"ate gkl�v\�e y,„koo. covi-t <br /> CONTRACTOR NAME: Q e,.v . ,, t" c -e. <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS UCENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: Of\l'w" CONTACT PHONE: L(Zj - 3 p_3y Z 3 <br /> CONTACT EMAIL: (3i'i"a hcr, 7€ yet(�tcam,C yr sr <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: v\�� j- 0 1Z,B,t) ` O <br /> g g: � eA���� Contract Price of Work:$ <br /> Proposed Use of Building: 01,4\4-1\ Heat Source: ❑Gas j lectric °Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ( Duplex ❑Multi-Family-#of Units: ❑Commercial ®0ladustrial <br /> Type of Project: °New Addition ❑Remodel ❑Repair OT.I. ❑Sign OSprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: Pd � v.t 04 _ $2Cov4, cVoir y 00 t".‘tot, , e1 & C,01(1\1 (=j,trl 3 <br /> nl,e, a w pt.e.y_,Ls- cAccji <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New .`X Addn Alteration _Repair Type of Project: _New XAddn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—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 1 Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting t Dishwasher Roof Drains <br /> i Clothes Dryer Hookups Other: I Clothes Washer Medical Gas <br /> I Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER-/SUPPRESSION SYSTEM <br /> Chemical or Water I INo.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 /> City of Everett Official Use Only <br /> PERMIT#G 1Bsiloc6 <br /> Owner!Aut orized Agent Signature Date (Revised 9/23/2016) <br />