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OLT PERMIT APPLICATION <br /> BUILDING I MECHANICAL/ PLUMBING I 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> iflit a : <br /> __ 1PROJECT SITE INFORMATION, <br /> PROJECT SITE ADDRESS: Z//7 GdrhBare/ /) PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION:` <br /> OWNER NAME: Tgh,<. jq/,/j/e f- /"or�iTENANT NAME(If Commercial): <br /> // <br /> OWNER MAILING ADDRESS: STREET 27 / are/ �a� Z 7^ <br /> ern' eve,e171 STATE (fir/ ZIP Q' %/ <br /> OWNER PHONE: 40s-- 4 ZO-. 43 74 OWNER EMAIL: <br /> CONTRACTOR NAME: Z/e,eriy r rJ, <br /> CONTRACTOR ADDRESS: STREET // 2/9 n4/9-* 5.5 ..F-24q ry G�etn yry <br /> CITY //.Pf—e-9 a 7( STATE WA- ZIP 9 <br /> CONTRACTOR PHONE: ZC -4.820- 99 3 )3 CONTRACTOR EMAIL: PGY�u/d62-7,�IGi4�r , 4'co"�Ce5 <br /> �.7f'� /Q.�L <br /> CONTRACTOR LICENSE#(REQUIRED): /3 49 311V CITY OF EVERETT BUSINESS LICENSE#(REQUIRE <br /> ggi D <br /> PRIMARY CONTACT: 0 OWNER XCONTRACTOR ❑OTHER(Please Specify) COLk 1-Gq 1 <br /> CONTACT NAME: / CONTACT PHONE: 206-.4S0 -9C'3 3 ,P ! 3r�J70l CONTACT EMAIL: Pew! L0��/ �/le/-71.51a <br /> iatdttatdtoatagakawaagoavBU,ILDINGPERMIT APPLICATION . 4 <br /> Existing Use of Building: ,Q 5/W et/}4 al Contract Price of Work:$ ,.5; C2.00. <br /> Proposed Use of Building: Ras/ ' i 74 seaI Heat Source: L>Gas DElectric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel I$Repair ❑T.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: re- -�2�/c2,7 0 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): .6 / of d 30 <br /> °, ,'AMECHANICAL PERMIT APPLICATION :`, , ` PLUMBING.PERMIT APPLICATION Ip <br /> Type of Project: New_ Addn)"Alteration !`Repair Type of Project: New Addn Alteration Repair i <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #°f List of Fixtures t <br /> Fixtures Fixtures Fixtures Fixtures 1 <br /> t <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 2.. Lavatory(Wash Basin) Drinking Fountain 1 <br /> / Water Heater Refrigeration / Shower Floor Drain 1 <br /> Gas Fireplace Wood Stove / Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting / Dishwasher Roof Drains 1 <br /> Clothes Dryer Hookups Other: / Clothes Washer Medical Gas <br /> / Range Hood it Water Heater Other: <br /> 3 Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> ( <br /> I <br /> S4RINKLER'1 SUPPRESSION S.YSTEM:Mintil g <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 properly 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 /> /©--/d--/p 0l Si D -- 00, n <br /> Owner/A ,ref* gent Signat a Date (Revised 10/12/2015) 1 <br />